Healthcare Provider Details

I. General information

NPI: 1982809133
Provider Name (Legal Business Name): MELISSA JO-ANN CUPID M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OMALARI RUDJU CUPID OFFICE MANAGER

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3236 HOLMESTOWN RD UNIT E1
MYRTLE BEACH SC
29588-7495
US

IV. Provider business mailing address

PO BOX 547
LITTLE RIVER SC
29566-0547
US

V. Phone/Fax

Practice location:
  • Phone: 843-663-8000
  • Fax: 843-663-8166
Mailing address:
  • Phone: 843-663-8013
  • Fax: 843-663-8166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200301427
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2021652
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: