MEDICARE: DR. MELODYE ELLIOTT VISSER MD

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	207Q00000X	Family Medicine Physician	0031921	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245316082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELODYE ELLIOTT VISSER MD

Provider Business Mailing Address
First Line	:	1202 MEDICAL CENTER DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28401-7307
Country	:	US
Telephone Number	:	910-341-3300
Fax Number	:	910-251-2067

Provider Business Practice Location Address
First Line	:	1300 BRIDGE BARRIER RD STE 2
Second Line	:
City	:	CAROLINA BEACH
State	:	NC
Zip	:	28428-3939
Country	:	US
Telephone Number	:	910-341-3300
Fax Number	:	910-251-2067

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	10/02/2019

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