Healthcare Provider Details

I. General information

NPI: 1891745790
Provider Name (Legal Business Name): MELISSA K DIXON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W WATER ST
TOMS RIVER NJ
08753
US

IV. Provider business mailing address

1580 LAKEWOOD RD STE 16
TOMS RIVER NJ
08755-3287
US

V. Phone/Fax

Practice location:
  • Phone: 732-244-4700
  • Fax: 732-244-2804
Mailing address:
  • Phone: 732-456-7777
  • Fax: 848-251-2189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA07564300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: