Provider Demographics
NPI:1396972352
Name:DAVIS, MELISSA ANN (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:333 CEDAR ST
Mailing Address - Street 2:P.O. BOX 208042
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3206
Mailing Address - Country:US
Mailing Address - Phone:803-479-6332
Mailing Address - Fax:864-455-1320
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:803-479-6332
Practice Address - Fax:864-455-1320
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2022-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT539812085N0700X, 2085R0202X
NC2012--001532085D0003X
GA848832085R0202X
SCLL31707208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRES000Medicare UPIN