Organization Name: | MELISSA PARK, MD INTERNAL MEDICINE |
NPI Number: | 1114935855 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHELLY RAE GRESHAM (OFFICE MANAGER) |
Mailing Address: | 4 Glen Cove Dr Suite 101 Rockport |
State: | ME US |
Postal Code: | 048564235 |
Phone Number: | 2075942609 |
Fax Number: | 2075944358 |
NPI Enumeration Date: | 08/04/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 015943 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |