DR. MELISSA AVIVA CLARK (NPI# 1346236775) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346236775 |
| Entity Type | Individual |
| Full Name | DR. MELISSA AVIVA CLARK |
| Credential | M.D. |
| Practice Address |
9710 Patuxent Woods Dr Suite 200 Columbia MD 21046-1526 |
| Mailing Address |
800s Frederick Ave 100 Gaithersburg MD 20877-4151 |
| Practice Telephone | 3015758080 |
| Mailing Telephone | 3013552013 |
| Mailing Fax Number | 3019630072 |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2015-07-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | D70056 | MD | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 036-105536 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036-105536 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902336753 | Melissa Lynn Clark | Audiologist | 69 Allen St Ste 1, Rutland, VT 05701-4564 | 2017-06-14 |
| 1245764638 | Melissa Clark | Social Worker | 2906 F St, Unit 6860, Eureka, CA 95502-4101 | 2017-04-12 |
| 1861843328 | Melissa Clark | Case Manager/Care Coordinator | 21 Seneca Dr, Horseheads, NY 14845-1082 | 2016-06-27 |
| 1982054862 | Melissa A Clark | Social Worker | 3142 W Fullerton Ave Apt 1, Chicago, IL 60647-7997 | 2016-06-21 |
| 1518236900 | Melissa Yvonne Clark | Counselor | 1131 Ionia Ave Nw, Grand Rapids, MI 49503-1020 | 2011-12-14 |
| 1063799682 | Melissa Newkam Clark | Occupational Therapist | 5745 Old Winder Hwy Ste C, Braselton, GA 30517-1637 | 2011-11-10 |
| 1114160199 | Melissa Ann Clark | Licensed Practical Nurse | 113 Cheney St, Syracuse, NY 13207 | 2009-04-07 |
| 1902084858 | Melissa Clark | Registered Nurse | 3251 West 9th Street, Waterloo, IA 50702 | 2008-02-02 |
| 1447462189 | Melissa Kipp Clark | Audiologist | 5304 Manatee Ave W, Bradenton, FL 34209-3743 | 2007-05-04 |
| 1548398506 | Melissa Darlene Clark | Licensed Practical Nurse | 105 Waverly Plz, Waverly, TN 37185-1531 | 2007-03-01 |
| Street Address |
9710 PATUXENT WOODS DR SUITE 200 |
| City | COLUMBIA |
| State | MD |
| Zip Code | 21046-1526 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144718792 | Premier Health Express and Advanced Diagnostics Inc | Clinic/Center | 9710 Patuxent Woods Dr, Columbia, MD 21046-1526 | 2018-04-30 |
| 1720520810 | Your Health Network | Clinic/Center | 9710 Patuxent Woods Dr, Suite 200, Columbia, MD 21046-1526 | 2016-11-07 |
| 1245782010 | Grace Fitzpatrick | Nurse Practitioner | 9710 Patuxent Woods Dr, Suite 200, Columbia, MD 21046-1526 | 2016-10-27 |
| 1144673583 | Grace Rudatsikira | Social Worker | 9710 Patuxent Woods Dr, Suite 200, Columbia, MD 21046-1526 | 2016-07-21 |
| 1659769024 | Your Health Network, Inc. | Counselor | 9710 Patuxent Woods Dr, Suite 200, Columbia, MD 21046-1526 | 2015-01-07 |
| 1033517255 | Your Health Network, Inc. | Family Medicine | 9710 Patuxent Woods Dr, Suite 200, Columbia, MD 21046-1526 | 2014-12-22 |
| 1356771372 | Danielle Herrmann | Social Worker | 9710 Patuxent Woods Dr, Columbia, MD 21046-1526 | 2013-11-13 |
| 1619210960 | Amanda L Sollars | Family Medicine | 9710 Patuxent Woods Dr, Suite 200, Columbia, MD 21046-1526 | 2013-04-04 |
| 1497999775 | Adanma Ngozi Ndubuizu | Family Medicine | 9710 Patuxent Woods Dr, Suite 200, Columbia, MD 21046-1526 | 2009-04-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124628821 | Shadiat Ogunsakin | Behavior Technician | 7060 Samuel Morse Dr., Ste 100, Columbia, MD 21046 | 2020-10-30 |
| 1659983211 | Courtney Danielle Henderson | Behavior Technician | 10015 Old Columbia Road, Suite B215, Columbia, MD 21046 | 2020-08-17 |
| 1477116218 | Corporate Sourcing Solutions, Inc. | Nurse's Aide | 6700 Alexander Bell Dr., Suite 200, Columbia, MD 21046 | 2019-04-17 |
| 1497230973 | Quality Dme, Inc. | Durable Medical Equipment & Medical Supplies | 9175 Guilford Road, Suite 308, Columbia, MD 21046 | 2018-10-01 |
| 1649792698 | Sharon Londeree | Nurse Practitioner | 9710 Patuxent Woods Dr Ste 200, Columbia, MD 21046 | 2017-07-12 |
| 1043740624 | Katherine Green | Counselor | 6950 Columbia Gateway Drive, Columbia, MD 21046 | 2017-06-15 |
| 1710417548 | Karen Trageser | Registered Nurse | 7055 Samuel Morse Drive Suite 200, Columbia, MD 21046 | 2017-06-14 |
| 1396282745 | Emma Mayne | Technician, Other | 7175 Columbia Gateway Dr A, Columbia, MD 21046 | 2017-01-24 |
| 1861944795 | Ameris | Home Health | 6711 Columbia Gateway Drive, Suite 475, Columbia, MD 21046 | 2016-10-26 |
| 1073063426 | Chandni Bhatia | Counselor | 10005 Old Columbia Road (suite L260), Columbia, MD 21046 | 2016-10-10 |
| Find all providers in zip 21046 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447868005 | Brittany Mechelle Waterworth | Family Medicine | 3700 I 70 Dr Se Ste 106, Columbia, MO 65201-6587 | 2020-07-20 |
| 1730706839 | John James Gannon | Family Medicine | Prisma Health Medical Group Family Medicine, 3209 Colonial Drive, Columbia, SC 29203 | 2020-07-06 |
| 1053938852 | Garrison Glenn Rice | Family Medicine | Prisma Health Medical Group Family Medical Center, 3209 Colonial Drive, Columbia, SC 29203 | 2020-06-29 |
| 1457977563 | Jenny Tatiana Gonzalez Guzman | Family Medicine | Prisma Health Family Medical Center, 3209 Colonial Drive, Columbia, SC 29203 | 2020-06-24 |
| 1942825500 | Jarvis Jamal Johnson | Family Medicine | Prisma Health Family Medicine Center, 3209 Colonial Drive, Columbia, SC 29203 | 2020-06-10 |
| 1386268183 | Nicolas Anthony Limogiannis | Family Medicine | Prisma Health Medical Group Family Medicine Center, 3209 Colonial Drive, Columbia, SC 29203 | 2020-06-08 |
| 1730724220 | Luci Lee Redman Cassella | Family Medicine | 8900 Columbia 100 Parway Suite G, Columbia, MD 21045 | 2019-11-08 |
| 1275177420 | Palmetto Primary Care Physicians | Family Medicine | 1415 Blanding St Ste 2, Columbia, SC 29201-2922 | 2019-10-31 |
| 1558919852 | Synergos Medical, LLC | Family Medicine | 1703 Oak Cliff Pl, Columbia, MO 65203-4719 | 2019-08-29 |
| 1972156982 | Maury Regional Medical Group, Inc | Family Medicine | 2478 Nashville Hwy Ste A, Columbia, TN 38401-0634 | 2019-07-18 |
| Find all providers in COLUMBIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.