Healthcare Provider Details

I. General information

NPI: 1275505984
Provider Name (Legal Business Name): MELINDA ANN CAVICCHIA MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CLEARWATER HBR
SANFORD NC
27332-6691
US

IV. Provider business mailing address

DEPT OF THE ARMY, WAMC STOP A 2817 REILLY RD., MCXC-DPM LTC MELINDA A. CAVICCHIA
FORT BRAGG NC
28310-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-499-0893
  • Fax:
Mailing address:
  • Phone: 910-396-5022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34117-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number34117-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: