Provider Demographics
NPI:1760550065
Name:MCCRACKEN, MELISSA ANN DOLAN (PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN DOLAN
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13524 BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:HYDES
Mailing Address - State:MD
Mailing Address - Zip Code:21082-9746
Mailing Address - Country:US
Mailing Address - Phone:443-752-4388
Mailing Address - Fax:
Practice Address - Street 1:3333 N CALVERT ST
Practice Address - Street 2:SUITE 400
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2867
Practice Address - Country:US
Practice Address - Phone:410-554-2865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003436363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant