Basic Information
| Provider Information | |||||||||
| NPI: | 1467675181 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORTENSEN-WELCH | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPARTMENT OF SURGERY OTOLARYNGOLOGY | ||||||||
| Address2: | STONY BROOK UNIV MEDICAL CENTER, HSCT19-064 | ||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117948191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314448410 | ||||||||
| FaxNumber: | 6314447635 | ||||||||
| Practice Location | |||||||||
| Address1: | 37 RESEARCH WAY | ||||||||
| Address2: | STONY BROOK SURGICAL ASSOCIATES | ||||||||
| City: | EAST SETAUKET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117339200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314444121 | ||||||||
| FaxNumber: | 6314444189 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 07/25/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YS0012X | 2341737 | NY | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Sleep Medicine | 207YS0012X | 0101243259 | VA | N | Allopathic & Osteopathic Physicians | Otolaryngology | Sleep Medicine |
No ID Information.