MEDICARE: DR. MELISSA NOTHNAGLE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	151802	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	007061050	OTHER	RI	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023092806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA NOTHNAGLE MD

Provider Business Mailing Address
First Line	:	622 CONGRESS AVE
Second Line	:
City	:	PACIFIC GROVE
State	:	CA
Zip	:	93950-4114
Country	:	US
Telephone Number	:	401-419-4299
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 CONSTITUTION BLVD BLDG 4003
Second Line	:
City	:	SALINAS
State	:	CA
Zip	:	93906-3100
Country	:	US
Telephone Number	:	831-755-4111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	06/16/2022

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