Provider Demographics
NPI:1134176076
Name:KNIGHT, MELINDA K (MD)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:K
Last Name:KNIGHT
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:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02880-0229
Mailing Address - Country:US
Mailing Address - Phone:401-788-3929
Mailing Address - Fax:401-788-3939
Practice Address - Street 1:70 KENYON AVE UNIT 324
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4253
Practice Address - Country:US
Practice Address - Phone:401-788-8780
Practice Address - Fax:401-788-8787
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43471020208800000X
GA083903208800000X
RIMD17671208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34097500Medicaid
WI1134176076Medicaid
WI34097500Medicaid
WI1134176076Medicaid
WI000132420Medicare PIN