Provider Demographics
NPI:1104266220
Name:GULOSH, MELISSA (DPM)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GULOSH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:CURRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1500 DIXON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-7231
Mailing Address - Country:US
Mailing Address - Phone:540-374-5261
Mailing Address - Fax:540-374-5066
Practice Address - Street 1:1500 DIXON ST STE 201
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-7231
Practice Address - Country:US
Practice Address - Phone:540-374-5261
Practice Address - Fax:540-374-5066
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301237213ES0103X
OH003761213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery