Provider Demographics
NPI:1578745550
Name:MELVIN W RESSLER, MD SURGEON PC T/A GLOUCESTER SURGERY
Entity Type:Organization
Organization Name:MELVIN W RESSLER, MD SURGEON PC T/A GLOUCESTER SURGERY
Other - Org Name:GLOUCESTER SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ROXANNE
Authorized Official - Last Name:O'FERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-693-3400
Mailing Address - Street 1:PO BOX 980
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-0980
Mailing Address - Country:US
Mailing Address - Phone:804-693-3400
Mailing Address - Fax:804-693-9793
Practice Address - Street 1:7554 HOSPITAL DR
Practice Address - Street 2:STE 303
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-4178
Practice Address - Country:US
Practice Address - Phone:804-693-3400
Practice Address - Fax:804-693-9793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101228441208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7303718Medicaid
VAC08302Medicare PIN