MEDICARE: MRS. MELISSA J KIRICHIAN NP

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
1	363LA2200X	Adult Health Nurse Practitioner	2005007275-21	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NP9637	OTHER	MA	BCBS

General Provider Information

NPI Number	:	1518986306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA J KIRICHIAN NP

Provider Business Mailing Address
First Line	:	292 BERKLEY ST
Second Line	:
City	:	TAUNTON
State	:	MA
Zip	:	02780-4924
Country	:	US
Telephone Number	:	774-218-5419
Fax Number	:	508-880-5247

Provider Business Practice Location Address
First Line	:	72 WASHINGTON ST
Second Line	:	SUITE 1400-1700
City	:	TAUNTON
State	:	MA
Zip	:	02780-2491
Country	:	US
Telephone Number	:	508-880-0077
Fax Number	:	508-880-5247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	08/28/2007

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