Provider Demographics
NPI:1982809133
Name:WEATHERSPOON 'CUPID, MELISSA JO-ANN (MD)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JO-ANN
Last Name:WEATHERSPOON 'CUPID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OMALARI
Other - Middle Name:RUDJU
Other - Last Name:CUPID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OFFICE MANAGER
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-0547
Mailing Address - Country:US
Mailing Address - Phone:843-663-8013
Mailing Address - Fax:843-663-8166
Practice Address - Street 1:4303 LIVE OAK DR
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-9138
Practice Address - Country:US
Practice Address - Phone:843-663-8013
Practice Address - Fax:843-663-8166
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2021652207Q00000X
NC200301427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC216527Medicaid
NC5902508Medicaid
NCH23091Medicare UPIN