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General NPI Number Information
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NPI Number | 1669601282
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Entity Type | Individual
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Provider Name | MELISSA MAE PIETRAS PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | FORT BELVOIR COMMUNITY HOSPITAL 9300 DEWITT LOOP
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City | FORT BELVOIR
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State | VA
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Zip | 22060
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Country | US
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Telephone | 571-231-3224
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Fax |
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Provider Business Mailing Address
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Address Line | 3109 WATERSIDE LN
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City | ALEXANDRIA
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State | VA
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Zip | 22309-2131
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Country | US
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Telephone | 616-826-1886
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C0005879
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601005352
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License Number State | MI
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