Provider Demographics
NPI:1578671293
Name:TRIBUIANI, MELISSA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:TRIBUIANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 824804
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-4804
Mailing Address - Country:US
Mailing Address - Phone:302-575-8040
Mailing Address - Fax:302-575-8005
Practice Address - Street 1:701 N CLAYTON ST
Practice Address - Street 2:MSB SUITE 200
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3165
Practice Address - Country:US
Practice Address - Phone:302-575-8040
Practice Address - Fax:302-575-8005
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H04278Medicare UPIN
DE004120Medicare PIN
PA0000989001Medicaid
9336OtherCOVENTRY
004120F90Medicare ID - Type Unspecified
292295OtherALLIANCE
510064326OtherAETNA USHC
0000989001OtherDELAWARE PHYSICIANS CARE
H04278OtherBCBS OF DE
0096971000OtherAMERIHEALTH