MEDICARE: DR. MELISSA LYNN MCCAW DVM

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	174M00000X	Veterinarian	0301201559	VA

General Provider Information

NPI Number	:	1457655128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA LYNN MCCAW DVM

Provider Business Mailing Address
First Line	:	14828 POTOMAC BRANCH DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-4074
Country	:	US
Telephone Number	:	703-859-3443
Fax Number	:

Provider Business Practice Location Address
First Line	:	12733 BRAEMAR VILLAGE PLZ
Second Line	:
City	:	BRISTOW
State	:	VA
Zip	:	20136-5501
Country	:	US
Telephone Number	:	703-368-7301
Fax Number	:	703-368-7301

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

Provider Enumeration Date	:	01/10/2011
Last Update Date	:	01/10/2011

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