Provider Demographics
NPI:1790775096
Name:PFITZER, MELISSA GAYLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:GAYLE
Last Name:PFITZER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4700 E OAK ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:OAK ISLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28465-5257
Mailing Address - Country:US
Mailing Address - Phone:910-278-6414
Mailing Address - Fax:910-278-6417
Practice Address - Street 1:1506 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4871
Practice Address - Country:US
Practice Address - Phone:910-254-4065
Practice Address - Fax:910-254-4067
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103744363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2758589AMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #
NCP23219Medicare UPIN