Provider Demographics
NPI:1881691624
Name:LEMIECH, MELISSA (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LEMIECH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1147
Mailing Address - Country:US
Mailing Address - Phone:413-733-9600
Mailing Address - Fax:413-732-6534
Practice Address - Street 1:3455 MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1147
Practice Address - Country:US
Practice Address - Phone:413-733-9600
Practice Address - Fax:413-732-6534
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1122363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
970014196OtherRAILROAD MEDICARE
112200OtherCONNECTICARE
970014196OtherRAILROAD MEDICARE
P05423Medicare UPIN