Provider Demographics
NPI:1609839091
Name:MATTSON, MELANIE DANIELLE (MD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:DANIELLE
Last Name:MATTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2896
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:1880 AMHERST STREET
Practice Address - Street 2:SUITE 100 AND SUITE 200
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-662-0306
Practice Address - Fax:855-264-2066
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101642786207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412529100Medicaid
VA006012124Medicaid
WV0075072000Medicaid
2119642OtherMAMSI PROFESSIONAL
100465OtherANTHEM PROFESSIONAL
44155OtherSENTARA PROFESSIONAL
VAC00085OtherVA MEDICARE GROUP
P00656342OtherRAILROAD MEDICARE
WV000553833OtherWV BLUE SHIELD
08247400000OtherQUALCHOICE PROFESSIONAL
WV3810003817OtherWV MEDICAID GROUP
MD550941600OtherMD MEDICARE GROUP
MD550941600OtherMD MEDICARE GROUP
100465OtherANTHEM PROFESSIONAL
VAMC10500Medicare PIN