Healthcare Provider Details

I. General information

NPI: 1306291760
Provider Name (Legal Business Name): ROMAN GEBREMESKEL MELVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PEDIATRIC RESIDENCY PROGRAM UNC SCHOOL OF MEDICINE, CAMPUS BOX 7593
CHAPEL HILL NC
27599-7593
US

IV. Provider business mailing address

PEDIATRIC RESIDENCY PROGRAM UNC SCHOOL OF MEDICINE, CAMPUS BOX 7593
CHAPEL HILL NC
27599-7593
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-3172
  • Fax:
Mailing address:
  • Phone: 919-966-3172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number218154
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: