Provider Demographics
NPI:1598843518
Name:MARTIN, MELANIE J (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:J
Last Name:MARTIN
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:PO BOX 602658
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2658
Mailing Address - Country:US
Mailing Address - Phone:336-716-2011
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-713-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800326207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1598843518Medicaid
NC8911757Medicaid
NC267252OtherMEDCOST
VA1598843518OtherVIRGINIA MEDICAID
NC11757OtherBCBS
NC5345685OtherAETNA
NC159884518OtherTRICARE
NC26184OtherPARTNERS MEDICARE
NCB1928OtherMEDCOST
NC1840740OtherUNITED HEALTHCARE
NC11757OtherBCBS OF NC
NC1598843518OtherPARTNERS
SCQ0032QOtherSC MEDICAID
NC110172194Medicare ID - Type UnspecifiedRR MEDICARE
VA1598843518OtherVIRGINIA MEDICAID
NCG73548Medicare UPIN
NC2258171AMedicare ID - Type UnspecifiedMEDICARE