Healthcare Provider Details

I. General information

NPI: 1598714131
Provider Name (Legal Business Name): MORTON MELTZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 OWEN DR
FAYETTEVILLE NC
28304-3417
US

IV. Provider business mailing address

PO BOX 42510
FAYETTEVILLE NC
28309-2510
US

V. Phone/Fax

Practice location:
  • Phone: 910-221-3030
  • Fax:
Mailing address:
  • Phone: 910-221-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6758593
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number15665
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15665
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number15665
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number15665
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: