Provider Demographics
NPI:1578569711
Name:TONELLI, MELINDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:M
Last Name:TONELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 ALBANY ST FL GROUND
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 MASSACHUSETTS AVE
Practice Address - Street 2:CROSSTOWN 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2526
Practice Address - Country:US
Practice Address - Phone:617-414-7399
Practice Address - Fax:617-414-9201
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA282983207R00000X
MTMED-PHYS-LIC-60160207R00000X
CODR.0053798207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO360425YT22Medicare PIN
COP01363768OtherRR MEDICARE
CO06020372Medicaid
CO360425YT22Medicare PIN