Healthcare Provider Details

I. General information

NPI: 1124129226
Provider Name (Legal Business Name): MELISSA JEAN MILES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA JEAN MURPHY PA

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WILBRAHAM RD
SPRINGFIELD MA
01109-3161
US

IV. Provider business mailing address

280 CHESTNUT ST 2ND FLOOR
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-3710
  • Fax: 413-794-9595
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number002214
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1960
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: