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NPI Code Detail

MEDICARE: MELISSA ANNE BERETICH MD

MEDICARE: MELISSA ANNE BERETICH 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
1207R00000XInternal Medicine Physician200501363NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1142CGOTHERNCBCBS OF NC
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588623078
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA ANNE BERETICH MD
Provider Business Mailing Address
First Line : 101 DOGWOOD DR
Second Line :
City : GREENVILLE
State : NC
Zip : 27834-6421
Country : US
Telephone Number : 252-947-0485
Fax Number :
Provider Business Practice Location Address
First Line : 628 E 12TH ST
Second Line : ATTN JAMES MANNING
City : WASHINGTON
State : NC
Zip : 27889-3409
Country : US
Telephone Number : 252-946-0900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2006
Last Update Date : 10/21/2010

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Directions to “ MELISSA ANNE BERETICH MD” Practice Location

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