Provider Demographics
NPI:1578869558
Name:RAY, MELANIE GLASS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:GLASS
Last Name:RAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1700 REISTERSTOWN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2938
Mailing Address - Country:US
Mailing Address - Phone:410-469-5555
Mailing Address - Fax:410-469-4811
Practice Address - Street 1:1700 REISTERSTOWN RD STE 102
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2938
Practice Address - Country:US
Practice Address - Phone:410-469-5555
Practice Address - Fax:410-469-4811
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105878363AM0700X, 363AS0400X
MDC06807363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical