Provider Demographics
NPI:1780634386
Name:EUBANKS, MELANIE JESSUP (DPM)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:JESSUP
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:1548 UNION RD STE D
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5530
Mailing Address - Country:US
Mailing Address - Phone:704-610-7474
Mailing Address - Fax:704-610-7475
Practice Address - Street 1:2391 COURT DR STE 100
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2197
Practice Address - Country:US
Practice Address - Phone:704-867-7388
Practice Address - Fax:704-865-8999
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC494213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC081C1OtherBCBS
NC5908687Medicaid
NC7550724OtherAETNA
NC24300Medicare PIN