MEDICARE: MARRISSA C PELLETIER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	243167	NY
2	208000000X	Pediatrics Physician	2014-00372	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1083816912	OTHER	NC	HUMANA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	9208288	OTHER	NC	CIGNA GREATWEST
4	984960	OTHER	GA	WELLCARE
5	003145877A	OTHER	GA	PEACHCARE 4 KIDS
6	4302375	OTHER	NC	COVENTRY NATIONAL - COVENTRY PPO
7	FH1101660	OTHER	NC	FIRST CAROLINA CARE
8	1083816912	OTHER	NC	HEALTHSMART
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	12669052	OTHER	NC	PHCS-MULTIPLAN
11	1461884	OTHER	NC	WELLPATH
12	186BW	OTHER	NC	BCBS OF NC
13	276479	OTHER	NC	MEDCOST, LLC
14	2379703	OTHER		AMERIGROUP
15	2889619	OTHER	NC	UNITED HEALTHCARE
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	1083816912	OTHER	NC	HEALTHNET FEDERAL SERVICES
18	1083816912	OTHER	NC	DOCTORS DIRECT
19	1461884	OTHER	NC	COVENTRY OF THE CAROLINAS
20	9102458	OTHER	NC	AETNA

General Provider Information

NPI Number	:	1083816912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARRISSA C PELLETIER MD

Provider Business Mailing Address
First Line	:	PO BOX 647
Second Line	:
City	:	HOPE MILLS
State	:	NC
Zip	:	28348-0647
Country	:	US
Telephone Number	:	910-483-7337
Fax Number	:	910-483-0648

Provider Business Practice Location Address
First Line	:	427 HARRISON AVE
Second Line	:
City	:	FRANKLIN
State	:	NC
Zip	:	28734-2580
Country	:	US
Telephone Number	:	828-524-7337
Fax Number	:	828-369-1340

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	11/12/2015

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