Healthcare Provider Details

I. General information

NPI: 1811341068
Provider Name (Legal Business Name): MELISSA R ROSSI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA R MILLILI

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 BAKER AVENUE EXT STE 301
CONCORD MA
01742-2139
US

IV. Provider business mailing address

54 BAKER AVENUE EXT STE 301
CONCORD MA
01742-2139
US

V. Phone/Fax

Practice location:
  • Phone: 978-369-5282
  • Fax: 978-369-2926
Mailing address:
  • Phone: 978-369-5282
  • Fax: 978-369-2926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD000349400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2505
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: