Healthcare Provider Details

I. General information

NPI: 1134201411
Provider Name (Legal Business Name): MELISSA CLOUGH, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDWAY RD SUITE 401
MILFORD MA
01757
US

IV. Provider business mailing address

100 MEDWAY RD SUITE 401
MILFORD MA
01757
US

V. Phone/Fax

Practice location:
  • Phone: 508-634-7338
  • Fax: 508-634-7315
Mailing address:
  • Phone: 508-634-7338
  • Fax: 508-634-7315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number153089
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number153089
License Number StateMA

VIII. Authorized Official

Name: DR. MELISSA CLOUGH
Title or Position: OWNER
Credential: MD PC
Phone: 508-634-7338