Provider Demographics
NPI:1760421416
Name:KING, MELISSA W C (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:W C
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:W
Other - Last Name:SCHWARZSCHILD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9816 MAYLAND DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1457
Mailing Address - Country:US
Mailing Address - Phone:804-282-8510
Mailing Address - Fax:804-285-5750
Practice Address - Street 1:9816 MAYLAND DR
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1457
Practice Address - Country:US
Practice Address - Phone:804-282-8510
Practice Address - Fax:804-285-5750
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236370174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA446018OtherSOUTHERN HEALTH
VA10334497Medicaid
VA1760421416OtherUNITED HEALTHCARE
VA49D0227531OtherCLIA
VA541256850OtherAETNA
VA220205OtherANTHEM
VA5397773OtherCIGNA
VA66268OtherCARENET
VA10334497Medicaid
012473R71Medicare PIN