MEDICARE: MELANGE HEALTH SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1073884789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELANGE HEALTH SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 29234
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28229-9234
Country	:	US
Telephone Number	:	704-567-8690
Fax Number	:	704-536-6030

Provider Business Practice Location Address
First Line	:	4805 GREEN RD
Second Line	:	SUITE 103
City	:	RALEIGH
State	:	NC
Zip	:	27616-2848
Country	:	US
Telephone Number	:	919-806-0509
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	MR. MARK BROWN
Credential	:
Telephone Number	:	704-567-8690

Provider Enumeration Date	:	01/26/2012
Last Update Date	:	02/21/2014

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