Provider Demographics
NPI:1871646828
Name:MOEN, MELISSA MEYERS (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MEYERS
Last Name:MOEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2003 MEDICAL PKWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7992
Mailing Address - Country:US
Mailing Address - Phone:410-224-2228
Mailing Address - Fax:410-266-7778
Practice Address - Street 1:2003 MEDICAL PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7992
Practice Address - Country:US
Practice Address - Phone:410-224-2228
Practice Address - Fax:410-266-7778
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0034626207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC11670003OtherBSNCABSF
MD1212271OtherUHCARE
MD225047OtherMAMALP
MD41817701OtherBSBSPPO
MDS851M918Medicare ID - Type Unspecified