Provider Demographics
NPI:1306943766
Name:HILBORN, MELISSA A (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:HILBORN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:118 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-2621
Practice Address - Country:US
Practice Address - Phone:508-885-3025
Practice Address - Fax:508-885-4090
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5642363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1051985OtherNCCPA CERTIFICATION
P37438Medicare UPIN
P37438Medicare UPIN
NH0599OtherNH LICENSE