MEDICARE: DR. MELANIE JESSUP EUBANKS DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	494	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	081C1	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7550724	OTHER	NC	AETNA

General Provider Information

NPI Number	:	1780634386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELANIE JESSUP EUBANKS DPM

Provider Business Mailing Address
First Line	:	1548 UNION RD STE D
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-5530
Country	:	US
Telephone Number	:	704-610-7474
Fax Number	:	704-610-7475

Provider Business Practice Location Address
First Line	:	2391 COURT DR STE 100
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-2197
Country	:	US
Telephone Number	:	704-867-7388
Fax Number	:	704-865-8999

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	06/18/2020

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Directions to “ DR. MELANIE JESSUP EUBANKS DPM” Practice Location

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