Healthcare Provider Details

I. General information

NPI: 1669601282
Provider Name (Legal Business Name): MELISSA MAE PIETRAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FORT BELVOIR COMMUNITY HOSPITAL 9300 DEWITT LOOP
FORT BELVOIR VA
22060
US

IV. Provider business mailing address

3109 WATERSIDE LN
ALEXANDRIA VA
22309-2131
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-3224
  • Fax:
Mailing address:
  • Phone: 616-826-1886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005352
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0005879
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: