Provider Demographics
NPI:1790003598
Name:WISNER, MELISSA JOI (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JOI
Last Name:WISNER
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:44095 PIPELINE PLZ
Mailing Address - Street 2:SUITE 370
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5898
Mailing Address - Country:US
Mailing Address - Phone:703-858-3140
Mailing Address - Fax:571-223-3242
Practice Address - Street 1:44095 PIPELINE PLZ
Practice Address - Street 2:SUITE 370
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5898
Practice Address - Country:US
Practice Address - Phone:703-858-3140
Practice Address - Fax:571-223-3242
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2022-04-14
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Provider Licenses
StateLicense IDTaxonomies
VA0101253956207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine