MEDICARE: DR. MARIEL MELISSA LITZ M.D.

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	99-00089	NC

General Provider Information

NPI Number	:	1336150150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIEL MELISSA LITZ M.D.

Provider Business Mailing Address
First Line	:	350 PEE DEE AVE
Second Line	:	SUITE A
City	:	ALBEMARLE
State	:	NC
Zip	:	28001-4932
Country	:	US
Telephone Number	:	704-986-1500
Fax Number	:	336-676-6490

Provider Business Practice Location Address
First Line	:	350 PEE DEE AVE
Second Line	:	SUITE A
City	:	ALBEMARLE
State	:	NC
Zip	:	28001-4932
Country	:	US
Telephone Number	:	704-986-1500
Fax Number	:	336-641-3089

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	02/05/2014

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