Healthcare Provider Details

I. General information

NPI: 1548299290
Provider Name (Legal Business Name): MELISSA M CONGDON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 STRAWBERRY VLG
MILL VALLEY CA
94941-2372
US

IV. Provider business mailing address

1206 STRAWBERRY VLG
MILL VALLEY CA
94941-2372
US

V. Phone/Fax

Practice location:
  • Phone: 415-388-3364
  • Fax: 415-388-3385
Mailing address:
  • Phone: 415-388-3364
  • Fax: 415-388-3385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG65526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: