Provider Demographics
NPI:1639108392
Name:BORTHWICK, MELISSA L (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:BORTHWICK
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 1:89 S MAST RD
Mailing Address - Street 2:
Mailing Address - City:GOFFSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03045-6102
Mailing Address - Country:US
Mailing Address - Phone:603-497-5661
Mailing Address - Fax:603-497-5740
Practice Address - Street 1:89 S MAST RD
Practice Address - Street 2:
Practice Address - City:GOFFSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03045-6102
Practice Address - Country:US
Practice Address - Phone:603-497-5661
Practice Address - Fax:603-497-5740
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40000207P00000X
NH14371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine