Healthcare Provider Details

I. General information

NPI: 1013178094
Provider Name (Legal Business Name): MELISSA A MARTIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2008
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W CUMMINGS PARK STE 4050
WOBURN MA
01801-6372
US

IV. Provider business mailing address

800 W CUMMINGS PARK STE 4050
WOBURN MA
01801-6372
US

V. Phone/Fax

Practice location:
  • Phone: 781-787-3003
  • Fax: 781-281-2406
Mailing address:
  • Phone: 781-787-3003
  • Fax: 781-281-2406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number253266
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: