Provider Demographics
NPI:1710662960
Name:BISH, MELANIE JOYCE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:JOYCE
Last Name:BISH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6221 FREE STONE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4401
Mailing Address - Country:US
Mailing Address - Phone:850-876-9664
Mailing Address - Fax:
Practice Address - Street 1:4660 WILKENS AVE STE 205
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4846
Practice Address - Country:US
Practice Address - Phone:410-650-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC005587207RR0500X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology