Healthcare Provider Details

I. General information

NPI: 1437737715
Provider Name (Legal Business Name): JONATHAN DAVID MELO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 N 4TH ST
WILMINGTON NC
28401-3450
US

IV. Provider business mailing address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-0270
  • Fax: 910-251-1540
Mailing address:
  • Phone: 910-343-7000
  • Fax: 910-667-5650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2022-03005
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: