Provider Demographics
NPI:1851935134
Name:GLICKMAN, MELISSA ANNE (NP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANNE
Last Name:GLICKMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:ANNE
Other - Last Name:COATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:BETH ISRAEL DEACONESS MEDICAL CENTER
Mailing Address - Street 2:330 BROOKLINE AVE, SHAPIRO 7 BMT
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-667-9920
Mailing Address - Fax:617-667-3317
Practice Address - Street 1:BETH ISRAEL DEACONESS MEDICAL CENTER
Practice Address - Street 2:330 BROOKLINE AVE, SHAPIRO 7 BMT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-667-9920
Practice Address - Fax:617-667-3317
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2301678363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner