Provider Demographics
NPI:1629039557
Name:MORGAN, MELVIN KENNETH II (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:KENNETH
Last Name:MORGAN
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-768-9515
Mailing Address - Fax:336-768-9082
Practice Address - Street 1:400 JONESTOWN RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4623
Practice Address - Country:US
Practice Address - Phone:336-768-9515
Practice Address - Fax:336-768-9082
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2020-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC25935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8960745Medicaid
D26853Medicare UPIN
NC230816Medicare PIN