MEDICARE: MELISSA P.M. CISA 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	207V00000X	Obstetrics & Gynecology Physician	85609	SC

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

General Provider Information

NPI Number	:	1386176865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA P.M. CISA MD

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	:	3510 N HIGHWAY 17 STE 110
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-8228
Country	:	US
Telephone Number	:	843-606-8960
Fax Number	:	843-606-8961

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

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	04/06/2026

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