=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295034767
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELANIE MARIE KREINER MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2011
-----------------------------------------------------
Last Update Date | 06/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2406 BLUE RIDGE RD SUITE 100
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27607-6678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-786-5001
-----------------------------------------------------
Fax | 919-786-5051
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 CHILDRENS DR
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43205-2664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-722-4411
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 2014-00940
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------