Provider Demographics
NPI:1851345177
Name:O'HALLORAN, MELISSA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:A
Last Name:O'HALLORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:QUAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3625 W 65TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2106
Mailing Address - Country:US
Mailing Address - Phone:952-920-7001
Mailing Address - Fax:952-920-2245
Practice Address - Street 1:3625 W 65TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2106
Practice Address - Country:US
Practice Address - Phone:952-920-7001
Practice Address - Fax:952-920-2245
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48394207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3386961000Medicaid
MNI57441Medicare UPIN
MN3386961000Medicaid
MN160003497Medicare PIN