Provider Demographics
NPI:1548311673
Name:PALMER, MELISSA (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:PALMER
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 1:1097 OLD COUNTRY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-6505
Mailing Address - Country:US
Mailing Address - Phone:516-939-2626
Mailing Address - Fax:516-939-2804
Practice Address - Street 1:1097 OLD COUNTRY RD STE 104
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-6505
Practice Address - Country:US
Practice Address - Phone:516-939-2626
Practice Address - Fax:516-939-2804
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173318207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE95843Medicare UPIN
NY97F911Medicare ID - Type Unspecified