1265427330 NPI number — MELVIN L MORSE MD

Table of content: MELVIN L MORSE MD (NPI 1265427330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265427330 NPI number — MELVIN L MORSE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORSE
Provider First Name:
MELVIN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265427330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
611 FEDERAL ST
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
MILTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19968-1115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-684-1119
Provider Business Mailing Address Fax Number:
302-329-9234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 FEDERAL ST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
MILTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19968-1115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-684-1119
Provider Business Practice Location Address Fax Number:
302-329-9234
Provider Enumeration Date:
09/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  C1-0008267 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080A0000X , with the licence number: MD00019734 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1011543 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MO8678 . This is a "REG" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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