Provider Demographics
NPI:1710142914
Name:HARRIS-MARTORANA, MELISSA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:HARRIS-MARTORANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3909 WOODLEY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1169
Mailing Address - Country:US
Mailing Address - Phone:419-291-6720
Mailing Address - Fax:419-291-6729
Practice Address - Street 1:3909 WOODLEY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1169
Practice Address - Country:US
Practice Address - Phone:419-291-6720
Practice Address - Fax:419-291-6729
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.093681207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000627028OtherANTHEM
OH2975428Medicaid
OH000000627028OtherANTHEM