Provider Demographics
NPI:1093784035
Name:BELLINGHAUSEN, MELODY FAITH (DO)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:FAITH
Last Name:BELLINGHAUSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2301 S HAMPTON
Mailing Address - Street 2:STE 900
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224
Mailing Address - Country:US
Mailing Address - Phone:214-330-9201
Mailing Address - Fax:214-339-9577
Practice Address - Street 1:2301 S HAMPTON
Practice Address - Street 2:STE 900
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224
Practice Address - Country:US
Practice Address - Phone:214-330-9201
Practice Address - Fax:214-339-9577
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF6431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121462903Medicaid
TX752360359OtherTAX ID
D97206Medicare UPIN
TX00PB65Medicare PIN