Provider Demographics
NPI:1629148531
Name:DE LA ROZA, MELISSA BARNES (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:BARNES
Last Name:DE LA ROZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GPO BOX 29580
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-9580
Mailing Address - Country:US
Mailing Address - Phone:718-283-8773
Mailing Address - Fax:718-283-8796
Practice Address - Street 1:1240 HUFFMAN MILL RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8700
Practice Address - Country:US
Practice Address - Phone:336-538-7411
Practice Address - Fax:336-538-7041
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236450207PE0004X
NC2008 00499207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02689458Medicaid
NYI40139Medicare UPIN
NY1644Q1Medicare ID - Type Unspecified