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NPI Code Detail

MEDICARE: DR. MELISSA ROSE ELLIS-YARIAN D.O

MEDICARE: DR. MELISSA ROSE ELLIS-YARIAN D.O
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
1207Q00000XFamily Medicine Physician1566SC

General Provider Information

NPI Number : 1174786198
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MELISSA ROSE ELLIS-YARIAN D.O
Provider Business Mailing Address
First Line : PO BOX 751649
Second Line :
City : CHARLOTTE
State : NC
Zip : 28275-1649
Country : US
Telephone Number : 888-472-0043
Fax Number : 843-724-2440
Provider Business Practice Location Address
First Line : 1114 N MAIN ST
Second Line :
City : SUMMERVILLE
State : SC
Zip : 29483-7326
Country : US
Telephone Number : 843-212-8070
Fax Number : 843-212-8071
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2008
Last Update Date : 08/21/2025

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