Provider Demographics
NPI:1477579514
Name:MELO-LIZARDO, ISAIAS E (MD)
Entity Type:Individual
Prefix:
First Name:ISAIAS
Middle Name:E
Last Name:MELO-LIZARDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6905 KNIGHTDALE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6506
Practice Address - Country:US
Practice Address - Phone:919-261-8760
Practice Address - Fax:919-261-8765
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9600820OtherNORTH CAROLINA MEDICAL BOARD LICENSE
NC5904314Medicaid
NC5904314Medicaid
NCNCQ799CMedicare PIN
NCNCQ799AMedicare PIN
NC9600820OtherNORTH CAROLINA MEDICAL BOARD LICENSE
NCNCQ799BMedicare PIN
NCNCQ799EMedicare PIN
NCBM9887401OtherDEA LICENSE