Provider Demographics
NPI:1861402273
Name:TRAZZERA, MELISSA L (DO)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:TRAZZERA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11724-2234
Mailing Address - Country:US
Mailing Address - Phone:631-367-2013
Mailing Address - Fax:
Practice Address - Street 1:470 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:COLD SPRING HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11724-2234
Practice Address - Country:US
Practice Address - Phone:631-367-2013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212705-1207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01946616Medicaid
NYG92546Medicare UPIN
NY01946616Medicaid