Healthcare Provider Details

I. General information

NPI: 1902017718
Provider Name (Legal Business Name): MELISSA FRISCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 MAIN STREET INOVA OCCUPATIONAL HEALTH 2ND FLOOR
FAIRFAX VA
22031
US

IV. Provider business mailing address

4508 DALTON RD
CHEVY CHASE MD
20815-3733
US

V. Phone/Fax

Practice location:
  • Phone: 703-279-4326
  • Fax:
Mailing address:
  • Phone: 301-986-4648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number0101055940
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: