Provider Demographics
NPI:1427083831
Name:WALTHER, MELISSA A (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:WALTHER
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 1:920 37TH PL STE 104
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6595
Mailing Address - Country:US
Mailing Address - Phone:772-794-5618
Mailing Address - Fax:772-794-5619
Practice Address - Street 1:920 37TH PL STE 104
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6595
Practice Address - Country:US
Practice Address - Phone:772-794-5618
Practice Address - Fax:772-794-5619
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061145A207Q00000X
FLME151768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200528610Medicaid
IN668810HMedicare ID - Type Unspecified
IN74755Medicare UPIN