Provider Demographics
NPI:1780610659
Name:LO, MELISSA (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LO
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 1:9621 RIDGETOP BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1780 NW MYHRE RD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8676
Practice Address - Country:US
Practice Address - Phone:360-782-3100
Practice Address - Fax:360-782-3112
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039970207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7098018OtherAETNA
WA8943766OtherCRIME VICTIMS COMP
WA0150782OtherLABOR & INDUSTRIES
1918RAOtherREGENCE BLUE SHIELD
160052725OtherRAILROAD MEDICARE
WA8277927Medicaid
WA8277927Medicaid
WAGAB21162Medicare PIN
BL6373764OtherDEA
160052725OtherRAILROAD MEDICARE
WAGAB21164Medicare PIN
WA8277927Medicaid
WAGAB21165Medicare PIN
WAGAB21161Medicare PIN
G8898916Medicare PIN
WAGAB21167Medicare PIN