Provider Demographics
NPI:1942294582
Name:GROSS, MELISSA FAITH (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:FAITH
Last Name:GROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 COMMERCIAL LN
Mailing Address - Street 2:WESTERN TIDEWATER COMMUNITY SERVICES BOARD
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8148
Mailing Address - Country:US
Mailing Address - Phone:757-942-1025
Mailing Address - Fax:757-925-2218
Practice Address - Street 1:1000 COMMERCIAL LN
Practice Address - Street 2:WESTERN TIDEWATER COMMUNITY SERVICES BOARD
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8148
Practice Address - Country:US
Practice Address - Phone:757-942-1025
Practice Address - Fax:757-925-2218
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010471092084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA284864OtherMAMSI
VA7103093Medicaid
VAO83568OtherOPTIMA FAMILY CARE
VA7103263Medicaid
VA7103379Medicaid
VA140068OtherTRIGON BCBS/HEALTHKEEPERS
VAO83568OtherOPTIMA FAMILY CARE