Provider Demographics
NPI:1619907334
Name:WONSICK, MELINDA DONELLE (MD)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:DONELLE
Last Name:WONSICK
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 1:200 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-9244
Mailing Address - Country:US
Mailing Address - Phone:336-846-7433
Mailing Address - Fax:336-846-7878
Practice Address - Street 1:200 HOSPITAL AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9244
Practice Address - Country:US
Practice Address - Phone:336-846-7433
Practice Address - Fax:336-846-7878
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891369HMedicaid
NCBCBSOther0173A
2030124Medicare ID - Type Unspecified
NC891369HMedicaid