Provider Demographics
NPI:1780697326
Name:MELTON, GWENESTA BARNUM (MD)
Entity type:Individual
Prefix:DR
First Name:GWENESTA
Middle Name:BARNUM
Last Name:MELTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 43905
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-3905
Mailing Address - Country:US
Mailing Address - Phone:910-323-1322
Mailing Address - Fax:910-323-1510
Practice Address - Street 1:2125 VALLEYGATE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3753
Practice Address - Country:US
Practice Address - Phone:910-323-1322
Practice Address - Fax:910-323-1510
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33712207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1408642OtherUNITED HEALTHCARE
660002162OtherRAILROAD MEDICARE
NC7958592Medicaid
58592OtherBLUE CROSS BLUE SHIELD
NC7958592Medicaid
213654Medicare ID - Type Unspecified