Provider Demographics
NPI:1124129226
Name:MILES, MELISSA JEAN (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:MILES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JEAN
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:11 WILBRAHAM RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-3161
Practice Address - Country:US
Practice Address - Phone:413-794-3710
Practice Address - Fax:413-794-9595
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002214363AM0700X
MAPA1960363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00322142Medicaid
CTD400068160 - C00814Medicare PIN
CT00322142Medicaid