Provider Demographics
NPI:1528016300
Name:MINTZER, MELANIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:MINTZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PRESTON EXECUTIVE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8457
Mailing Address - Country:US
Mailing Address - Phone:919-852-3999
Mailing Address - Fax:919-852-3444
Practice Address - Street 1:110 PRESTON EXECUTIVE DR
Practice Address - Street 2:SUITE 108
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8457
Practice Address - Country:US
Practice Address - Phone:919-852-3999
Practice Address - Fax:919-852-3444
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28064207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903068Medicaid
NC59530OtherBCBS PROVIDER NUMBER
NC208916EMedicare ID - Type UnspecifiedPROVIDER NUMBER
NCA50138Medicare UPIN