Provider Demographics
NPI:1083816912
Name:PELLETIER, MARRISSA C (MD)
Entity Type:Individual
Prefix:
First Name:MARRISSA
Middle Name:C
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-0647
Mailing Address - Country:US
Mailing Address - Phone:910-483-7337
Mailing Address - Fax:910-483-0648
Practice Address - Street 1:427 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-2580
Practice Address - Country:US
Practice Address - Phone:828-524-7337
Practice Address - Fax:828-369-1340
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY243167208000000X
NC2014-00372208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1083816912OtherHUMANA
NC1083816912Medicaid
NC9208288OtherCIGNA GREATWEST
GA984960OtherWELLCARE
GA003145877AOtherPEACHCARE 4 KIDS
NC4302375OtherCOVENTRY NATIONAL - COVENTRY PPO
NCFH1101660OtherFIRST CAROLINA CARE
NC1083816912OtherHEALTHSMART
NY02900278Medicaid
NC12669052OtherPHCS-MULTIPLAN
NC1461884OtherWELLPATH
NC186BWOtherBCBS OF NC
NC276479OtherMEDCOST, LLC
2379703OtherAMERIGROUP
NC2889619OtherUNITED HEALTHCARE
GA003145877AMedicaid
NC1083816912OtherHEALTHNET FEDERAL SERVICES
NC1083816912OtherDOCTORS DIRECT
NC1461884OtherCOVENTRY OF THE CAROLINAS
NC9102458OtherAETNA