Provider Demographics
NPI:1740573864
Name:MELOGRANA, NICOLE EDEN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:EDEN
Last Name:MELOGRANA
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:621 RIDGELY AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-224-4404
Mailing Address - Fax:410-224-2675
Practice Address - Street 1:621 RIDGELY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-224-4404
Practice Address - Fax:410-224-2675
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
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Provider Licenses
StateLicense IDTaxonomies
MAC0002638208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery