MEDICARE: MS. MELISSA FAYE GOLDBLATT C.P.N.P.

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	363LP0200X	Pediatric Nurse Practitioner	0024167398	VA

General Provider Information

NPI Number	:	1932306362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA FAYE GOLDBLATT C.P.N.P.

Provider Business Mailing Address
First Line	:	2300 E RANDOLPH AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-1132
Country	:	US
Telephone Number	:	703-684-1493
Fax Number	:

Provider Business Practice Location Address
First Line	:	6303 LITTLE RIVER TPKE
Second Line	:	SUITE 300
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-5000
Country	:	US
Telephone Number	:	703-914-8989
Fax Number	:	703-914-5494

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

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	07/08/2007

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