Provider Demographics
NPI:1609302769
Name:GOTT, MELISSA (DO)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 ANTHONY DR
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6212
Mailing Address - Country:US
Mailing Address - Phone:936-776-6271
Mailing Address - Fax:
Practice Address - Street 1:698 MULLICA HILL RD STE 300
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-4453
Practice Address - Country:US
Practice Address - Phone:856-641-8635
Practice Address - Fax:856-641-8636
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12730724-8904208600000X
390200000X
NJ25MB11955400208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program