Provider Demographics
NPI:1952502452
Name:LORA, MELISSA SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:SUE
Last Name:LORA
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 1:1411 W BELLA DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-5250
Mailing Address - Country:US
Mailing Address - Phone:765-651-6637
Mailing Address - Fax:765-651-6639
Practice Address - Street 1:1411 W BELLA DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-5250
Practice Address - Country:US
Practice Address - Phone:765-651-6637
Practice Address - Fax:765-651-6639
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1066345A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics