Provider Demographics
NPI:1093749004
Name:CROCHET, MELISSA KAY (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:KAY
Last Name:CROCHET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 LOS GAMOS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1850
Mailing Address - Country:US
Mailing Address - Phone:415-444-4440
Mailing Address - Fax:415-492-6215
Practice Address - Street 1:1650 LOS GAMOS DR STE 300
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1850
Practice Address - Country:US
Practice Address - Phone:415-444-4440
Practice Address - Fax:415-492-6215
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53333207VG0400X
TXK4400207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105836403Medicaid
TX8AD897OtherBC/BS
TX8C6355Medicare PIN
TX105836403Medicaid