Provider Demographics
NPI:1689748782
Name:DAVIS, MELISSA ANN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1440
Mailing Address - Country:US
Mailing Address - Phone:717-243-2561
Mailing Address - Fax:717-236-1121
Practice Address - Street 1:503 N 21ST ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2204
Practice Address - Country:US
Practice Address - Phone:717-972-4448
Practice Address - Fax:717-972-7366
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052179363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ63267Medicare UPIN
PA110017G7MMedicare PIN