Provider Demographics
NPI:1619256096
Name:FOCHTMAN, MELISSA A (RN)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:A
Last Name:FOCHTMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N BURHANS BLVD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-4677
Mailing Address - Country:US
Mailing Address - Phone:301-791-2660
Mailing Address - Fax:301-791-5032
Practice Address - Street 1:201 N BURHANS BLVD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4677
Practice Address - Country:US
Practice Address - Phone:301-791-2660
Practice Address - Fax:301-791-5032
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR156901163W00000X
PARN518221L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse