Provider Demographics
NPI:1811341068
Name:ROSSI, MELISSA R
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:ROSSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:R
Other - Last Name:MILLILI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:54 BAKER AVENUE EXT STE 301
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2139
Mailing Address - Country:US
Mailing Address - Phone:978-369-5282
Mailing Address - Fax:978-369-2926
Practice Address - Street 1:54 BAKER AVENUE EXT STE 301
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2139
Practice Address - Country:US
Practice Address - Phone:978-369-5282
Practice Address - Fax:978-369-2926
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD000349400213ES0103X
390200000X
MA2505213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program