Provider Demographics
NPI:1700953015
Name:FITZSIMMONS, MELANIE P (MD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:P
Last Name:FITZSIMMONS
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 1:301 US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7609
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:584 ROOSEVELT TRAIL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062
Practice Address - Country:US
Practice Address - Phone:207-892-3233
Practice Address - Fax:207-893-0752
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD17419208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME532621199Medicaid
NH30207092Medicaid
ME000116702Medicare PIN
ME000116701Medicare PIN
ME000116703Medicare PIN
ME000116704Medicare PIN
ME532621199Medicaid
MEP00928531Medicare PIN
NH30207092Medicaid
MEP00420625Medicare PIN