Healthcare Provider Details

I. General information

NPI: 1255221495
Provider Name (Legal Business Name): MELISSA CORKUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4904 YORK RD UNIT 4655
BALTIMORE MD
21212-7507
US

IV. Provider business mailing address

103 DUMBARTON RD APT C
BALTIMORE MD
21212-1411
US

V. Phone/Fax

Practice location:
  • Phone: 443-601-9682
  • Fax:
Mailing address:
  • Phone: 443-601-9682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: