1275505984 NPI number — DR. MELINDA ANN CAVICCHIA MD, MPH

Table of content: DR. MELINDA ANN CAVICCHIA MD, MPH (NPI 1275505984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275505984 NPI number — DR. MELINDA ANN CAVICCHIA MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAVICCHIA
Provider First Name:
MELINDA
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275505984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT OF THE ARMY, WAMC STOP A
Provider Second Line Business Mailing Address:
2817 REILLY RD., MCXC-DPM LTC MELINDA A. CAVICCHIA
Provider Business Mailing Address City Name:
FORT BRAGG
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28310-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-396-5022
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 CLEARWATER HBR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27332-6691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-499-0893
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  34117-020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2083P0901X , with the licence number: 34117-020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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