Healthcare Provider Details

I. General information

NPI: 1467602581
Provider Name (Legal Business Name): MELISSA GILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 SOUTHLAWN AVE
DOBBS FERRY NY
10522-3520
US

IV. Provider business mailing address

PO BOX 42
DOBBS FERRY NY
10522-0042
US

V. Phone/Fax

Practice location:
  • Phone: 917-518-1625
  • Fax:
Mailing address:
  • Phone: 917-518-1625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number230666-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number25MA08093300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number42121
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number062987
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number230666-1
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number25MA08093300
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number42121
License Number StateAZ
# 8
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number062987
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: