Provider Demographics
NPI:1801984612
Name:FOUGHT, MELISSA (NP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:FOUGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:
Practice Address - Street 1:4924 CAMPBELL BLVD STE 130
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5912
Practice Address - Country:US
Practice Address - Phone:443-997-2663
Practice Address - Fax:443-442-2089
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR150103207X00000X, 363LP0200X
CARN635939364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist