MEDICARE: DR. MELISSA A. CARLUCCI 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	2080P0205X	Pediatric Endocrinology Physician	055477	GA
2	2080P0205X	Pediatric Endocrinology Physician	2016-00107	NC
3	2080P0205X	Pediatric Endocrinology Physician	46856	TN

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	:	1386608404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA A. CARLUCCI M.D.

Provider Business Mailing Address
First Line	:	2920 HIGHWOODS BLVD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-0010
Country	:	US
Telephone Number	:	877-498-4490
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 SUNNYBROOK RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1855
Country	:	US
Telephone Number	:	919-350-7584
Fax Number	:

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	02/16/2021

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