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General NPI Number Information
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NPI Number | 1730650193
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Entity Type | Individual
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Provider Name | MELISSA ANNE LIRAG
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Gender | Female
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Dates
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Enumeration Date | 12/11/2018
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Last Update Date | 11/26/2021
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Provider Practice Location Address
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Address Line | 8081 INNOVATION PARK DR STE 800
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City | FAIRFAX
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State | VA
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Zip | 22031-4867
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Country | US
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Telephone | 571-472-4600
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Fax | 571-665-6885
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Provider Business Mailing Address
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Address Line | PO BOX 37174
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City | BALTIMORE
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State | MD
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Zip | 21297-3174
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Country | US
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Telephone | 571-423-5699
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Fax | 571-423-5698
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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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 | PA56543
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License Number State | CA
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