Provider Demographics
NPI:1437256815
Name:VANDE MAELE, DOMINIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIQUE
Middle Name:
Last Name:VANDE MAELE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100B E ALTON GLOOR BLVD
Mailing Address - Street 2:STE 260
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3376
Mailing Address - Country:US
Mailing Address - Phone:956-350-3901
Mailing Address - Fax:956-350-3900
Practice Address - Street 1:100B E ALTON GLOOR BLVD
Practice Address - Street 2:STE 260
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3376
Practice Address - Country:US
Practice Address - Phone:956-350-3901
Practice Address - Fax:956-350-3900
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3511208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030137602Medicaid
TX030137601Medicaid
TXG58647Medicare UPIN
TX030137602Medicaid
TX030137601Medicaid
TXP00669477Medicare PIN