Provider Demographics
NPI:1588623078
Name:BERETICH, MELISSA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:BERETICH
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 1:101 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6421
Mailing Address - Country:US
Mailing Address - Phone:252-947-0485
Mailing Address - Fax:
Practice Address - Street 1:628 E 12TH ST
Practice Address - Street 2:ATTN JAMES MANNING
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3409
Practice Address - Country:US
Practice Address - Phone:252-946-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501363207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC142CGOtherBCBS OF NC
NC5905245Medicaid
NC142CGOtherBCBS OF NC