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Individual
LISSA M MELVIN
Active
Individual
LISSA M MELVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
042041
CT
207VG0400X
Gynecology Physician
M6738
TX
207VM0101X
Maternal & Fetal Medicine Physician
Primary
M6738
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001420413
—
CT
05
—
1867277-01
—
TX
Enumeration date
11/22/2005
Last updated
11/07/2019
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