Provider Demographics
NPI:1063409613
Name:MELLON, CHRISTINE MARIE (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:MELLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 OAKRIDGE BLVD
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2351
Mailing Address - Country:US
Mailing Address - Phone:910-738-9601
Mailing Address - Fax:910-671-8261
Practice Address - Street 1:725 OAKRIDGE BLVD
Practice Address - Street 2:SUITE C-1
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2351
Practice Address - Country:US
Practice Address - Phone:910-738-9601
Practice Address - Fax:910-671-8261
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000-00896207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126H2Medicaid
NC126H2OtherBLUE CROSS BLUE SHIELD
NC126H2OtherBLUE CROSS BLUE SHIELD
NC89126H2Medicaid