Provider Demographics
NPI:1942466909
Name:DART, MELANIE ROSE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:ROSE
Last Name:DART
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 15109
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28408-5109
Mailing Address - Country:US
Mailing Address - Phone:910-392-2525
Mailing Address - Fax:910-392-2827
Practice Address - Street 1:1709 S 16TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6472
Practice Address - Country:US
Practice Address - Phone:910-452-8633
Practice Address - Fax:910-452-8569
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-03519363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant