Provider Demographics
NPI:1396831731
Name:CARTER, MELISSA LUANNE (DO)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LUANNE
Last Name:CARTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CRESCENT PARK WEST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2111
Mailing Address - Country:US
Mailing Address - Phone:814-723-2510
Mailing Address - Fax:814-723-4654
Practice Address - Street 1:2 CRESCENT PARK WEST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2111
Practice Address - Country:US
Practice Address - Phone:814-723-2510
Practice Address - Fax:814-723-4654
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013006207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019097160005Medicaid
PA0019097160004Medicaid
086287GZNMedicare PIN
PA086287Medicare PIN
PA0019097160005Medicaid
H29676Medicare UPIN