MEDICARE: DR. MELISSA M CONGDON 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
1	208000000X	Pediatrics Physician	G65526	CA

General Provider Information

NPI Number	:	1548299290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA M CONGDON M.D.

Provider Business Mailing Address
First Line	:	1206 STRAWBERRY VLG
Second Line	:
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-2372
Country	:	US
Telephone Number	:	415-388-3364
Fax Number	:	415-388-3385

Provider Business Practice Location Address
First Line	:	1206 STRAWBERRY VLG
Second Line	:
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-2372
Country	:	US
Telephone Number	:	415-388-3364
Fax Number	:	415-388-3385

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

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	07/08/2007

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