Provider Demographics
NPI:1871646828
Name:MOEN, MELISSA MEYERS (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MEYERS
Last Name:MOEN
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 1:150 GLEN OBAN DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2105
Mailing Address - Country:US
Mailing Address - Phone:410-693-9183
Mailing Address - Fax:
Practice Address - Street 1:150 GLEN OBAN DR
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2105
Practice Address - Country:US
Practice Address - Phone:410-693-9183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0034626207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC11670003OtherBSNCABSF
MD484591900Medicaid
MD1212271OtherUHCARE
MD225047OtherMAMALP
MD41817701OtherBSBSPPO