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General NPI Number Information
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NPI Number | 1124511167
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Entity Type | Individual
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Provider Name | MELISEANNA KATERINA ELIZABETH GIBBONS MD
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Gender | Female
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 12/10/2021
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Provider Practice Location Address
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Address Line | 101 WELLNESS WAY STE 200
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City | MILFORD
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State | DE
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Zip | 19963-4366
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Country | US
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Telephone | 302-430-0867
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Fax | 302-430-0421
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Provider Business Mailing Address
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Address Line | 640 S. STATE STREET, MAIL CODE 3055
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City | DOVER
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State | DE
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Zip | 19901-3530
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Country | US
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Telephone | 302-480-1688
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Fax | 302-480-9807
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C1-0024358
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License Number State | DE
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