Provider Demographics
NPI:1881891315
Name:FRITSCHE, MELISSA D (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:D
Last Name:FRITSCHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 E MAIN ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-2245
Mailing Address - Country:US
Mailing Address - Phone:864-586-3979
Mailing Address - Fax:864-327-8170
Practice Address - Street 1:1451 E MAIN ST STE 2A
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-2245
Practice Address - Country:US
Practice Address - Phone:864-586-3979
Practice Address - Fax:864-327-8170
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29722207Q00000X
SCLL29722207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5916137Medicaid
SCP00869625OtherRAILROAD MEDICARE
SC297226Medicaid
SCP00869625OtherRAILROAD MEDICARE