Clark, Melissa Aviva
Clark, Melissa Aviva is an individual health care provider with primary practice located at 9710 Patuxent Woods Dr Suite 200, Columbia MD 21046-1526. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Clark, Melissa Aviva can be contacted via phone (301) 575-8080.Contact Information
Primary practice address
9710 Patuxent Woods Dr Suite 200
Columbia MD 21046-1526
Phone: (301) 575-8080
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 036-105536 | Illinois |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | D70056 | Maryland |
Profile Details
| NPI number | 1346236775 |
|---|---|
| LBN Legal business name | Clark, Melissa Aviva |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 21st, 2005 |
| Last updated | Jul 14th, 2015 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1346236775 | NPPES |
| Illinois | MEDICAID | 036-105536 |
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