Provider Demographics
NPI:1740365931
Name:FARROW, MELISSA M (PA-C)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:M
Last Name:FARROW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:M
Other - Last Name:FRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5211 SOUTH COLLEGE ROAD
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:5211 SOUTH COLLEGE ROAD
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2209
Mailing Address - Country:US
Mailing Address - Phone:910-341-3300
Mailing Address - Fax:910-251-2067
Practice Address - Street 1:5211 S COLLEGE RD
Practice Address - Street 2:ATTN: CREDENTIALING
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2209
Practice Address - Country:US
Practice Address - Phone:910-341-3300
Practice Address - Fax:910-251-2067
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052839363A00000X
NC0010-06775363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q73109Medicare UPIN