Individual
MICHELLE ELAINE MELICOSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
707 N BROADWAY, KENNEDY KRIEGER INSTITUTE, BALTIMORE, MD 21205-1832
(443) 923-9446
(443) 923-9445
Mailing address
707 N BROADWAY, KENNEDY KRIEGER INSTITUTE, BALTIMORE, MD 21205-1832
(443) 923-9446
(443) 923-9445
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
153384
MA
208000000X
Pediatrics Physician
Primary
D0078581
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
541054100
—
MD
05
—
79426778
—
NM
05
—
970774
—
AZ
Enumeration date
03/22/2006
Last updated
03/17/2017
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