Provider Demographics
NPI:1760490809
Name:MOL-PELTON, MELISSA C (PA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:C
Last Name:MOL-PELTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BIRNIE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1107
Mailing Address - Country:US
Mailing Address - Phone:413-785-4666
Mailing Address - Fax:413-846-4756
Practice Address - Street 1:300 BIRNIE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1107
Practice Address - Country:US
Practice Address - Phone:413-785-4666
Practice Address - Fax:413-846-4756
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2647363A00000X
CT001036363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TINOtherPIONEER
CTP3511336OtherOXFORD HEALTH PLANS
CT10036OtherCONNECTICARE
CT290001036CT01OtherANTHEM BC/BS
TINOtherMULTIPLAN
TINOtherCORVEL
CT2V6007OtherHEALTH NET
TINOtherBERKELY ADMINISTRATORS
TINOtherNORTHEAST HEALTH DIRECT
TINOtherIONTEGRATED HEALTH PLAN
P17324Medicare UPIN
TINOtherPIONEER
CT10036OtherCONNECTICARE