Provider Demographics
NPI:1740259878
Name:BENDER, MELISSA AMY (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:AMY
Last Name:BENDER
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT STREET GRJ 504
Practice Address - Street 2:MASSACHUSETTS GENERAL HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-3812
Practice Address - Fax:617-726-7416
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA218418207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2014203Medicaid
MAJ26276OtherBCBS MA
MA218418OtherTUFTS HEALTH PLAN
H88288Medicare UPIN
MA218418OtherTUFTS HEALTH PLAN