Provider Demographics
NPI:1942417183
Name:BISSRAM, MELISHA (MD)
Entity Type:Individual
Prefix:
First Name:MELISHA
Middle Name:
Last Name:BISSRAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:739 THIMBLE SHOALS BLVD
Practice Address - Street 2:SUITE 801
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3562
Practice Address - Country:US
Practice Address - Phone:757-873-1009
Practice Address - Fax:757-873-7689
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101243205207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1942417183Medicaid
VAP00811057Medicare PIN
VA1942417183Medicaid