Provider Demographics
NPI:1871562876
Name:RODARTE, MELODY MEDAWAR (DO)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:MEDAWAR
Last Name:RODARTE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 S HIGLEY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4786
Mailing Address - Country:US
Mailing Address - Phone:480-571-1000
Mailing Address - Fax:888-366-1988
Practice Address - Street 1:1485 S HIGLEY RD STE 104
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4786
Practice Address - Country:US
Practice Address - Phone:480-571-1000
Practice Address - Fax:888-366-1988
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4047207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ940834Medicaid
AZZ119795Medicare PIN
AZ940834Medicaid