Provider Demographics
NPI:1356424550
Name:GLICK, MELISSA (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GLICK
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1000
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:413-794-1629
Practice Address - Street 1:3300 MAIN ST
Practice Address - Street 2:3RD FLOOR SUITE C&D
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01199-1002
Practice Address - Country:US
Practice Address - Phone:413-794-7491
Practice Address - Fax:413-794-7136
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2021-11-01
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Provider Licenses
StateLicense IDTaxonomies
MA1341363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ16610Medicare UPIN