Healthcare Provider Details

I. General information

NPI: 1003494568
Provider Name (Legal Business Name): MELANIE RUSSELL-GILLETTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 MEDICAL PARK DR
DURHAM NC
27704-2388
US

IV. Provider business mailing address

231 ALBERT SABIN WAY PO BOX 0531
CINCINNATI OH
45267-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-668-8277
  • Fax:
Mailing address:
  • Phone: 513-558-6356
  • Fax: 513-558-0995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number57.250887
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: