Provider Demographics
NPI:1053598508
Name:BOPP, MELANIE (PHD, RD, LDN)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:BOPP
Suffix:
Gender:F
Credentials:PHD, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1059
Mailing Address - Country:US
Mailing Address - Phone:336-327-9464
Mailing Address - Fax:
Practice Address - Street 1:3407 MADISON AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1059
Practice Address - Country:US
Practice Address - Phone:336-327-9464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC002477133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered