Healthcare Provider Details

I. General information

NPI: 1609073436
Provider Name (Legal Business Name): MARIA MELCHIONNO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE ST AMBULATORY CARE
CAMBRIDGE MA
02139-1047
US

IV. Provider business mailing address

22 THURMAN ST
EVERETT MA
02149-4140
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-1919
  • Fax:
Mailing address:
  • Phone: 617-387-3947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number156062
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: