Individual
MELVIN BERNARD PALMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
730 THIMBLE SHOALS BLVD, SUITE 130, NEWPORT NEWS, VA 23606-4562
(757) 873-1554
(757) 873-3239
Mailing address
730 THIMBLE SHOALS BLVD, SUITE 130, NEWPORT NEWS, VA 23606-4562
(757) 873-1554
(757) 873-3239
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110003940
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110003940
VA STATE LICENSE
VA
01
—
1669736971
TRICARE
VA
05
—
1669736971
—
VA
01
—
556062
BLUE CROSS BLUE SHIELD MEDICARE SUPPLEMENT
VA
Enumeration date
07/02/2012
Last updated
06/11/2019
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