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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 10 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346236775 NPPES
Illinois MEDICAID 036-105536

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