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NPI Code Detail

MEDICARE: DR. MELISSA FEARS M.D.

MEDICARE: DR. MELISSA FEARS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician280352NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417149030
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MELISSA FEARS M.D.
Provider Business Mailing Address
First Line : 2257 ADAM CLAYTON POWELL JR BLVD
Second Line :
City : NEW YORK
State : NY
Zip : 10027-7979
Country : US
Telephone Number : 212-281-5252
Fax Number :
Provider Business Practice Location Address
First Line : 2257 ADAM CLAYTON POWELL JR BLVD
Second Line :
City : NEW YORK
State : NY
Zip : 10027-7979
Country : US
Telephone Number : 212-281-5252
Fax Number : 212-348-5194
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2007
Last Update Date : 08/18/2022

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