Provider Demographics
NPI:1265427330
Name:MORSE, MELVIN L (MD)
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:L
Last Name:MORSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 FEDERAL ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-1115
Mailing Address - Country:US
Mailing Address - Phone:302-684-1119
Mailing Address - Fax:302-329-9234
Practice Address - Street 1:611 FEDERAL ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-1115
Practice Address - Country:US
Practice Address - Phone:302-684-1119
Practice Address - Fax:302-329-9234
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0008267208000000X
WAMD000197342080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1011543Medicaid
WAMO8678OtherREG