Provider Demographics
NPI:1740272020
Name:PALAZZO, MELISSA S (MD)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:S
Last Name:PALAZZO
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 1:400 N STATE OF FRANKLIN RD
Mailing Address - Street 2:ROOM 2746
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6035
Mailing Address - Country:US
Mailing Address - Phone:423-431-2390
Mailing Address - Fax:423-431-6715
Practice Address - Street 1:400 N STATE OF FRANKLIN RD
Practice Address - Street 2:ROOM 2746
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6035
Practice Address - Country:US
Practice Address - Phone:423-431-2390
Practice Address - Fax:423-431-6715
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021636174400000X
TN43626207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507621Medicaid
LAG22072Medicare UPIN
TN3002231Medicare PIN