Provider Demographics
NPI:1245282524
Name:NEAL, MELISSA ADA LOUISE (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ADA LOUISE
Last Name:NEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:766 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1417
Mailing Address - Country:US
Mailing Address - Phone:716-880-6521
Mailing Address - Fax:
Practice Address - Street 1:410 ELMWOOD AVE
Practice Address - Street 2:LOWER FLOOR
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2210
Practice Address - Country:US
Practice Address - Phone:716-462-5437
Practice Address - Fax:888-511-0393
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-82944207W00000X
NY241552207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H92949Medicare UPIN
OH4415074Medicare ID - Type UnspecifiedKAISER