Provider Demographics
NPI:1588838031
Name:PICKERING, MELANIE RAE (DO)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:RAE
Last Name:PICKERING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MELANIE
Other - Middle Name:RAE
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:8020 CONSTITUTION PL NE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7607
Mailing Address - Country:US
Mailing Address - Phone:505-998-3096
Mailing Address - Fax:505-998-3100
Practice Address - Street 1:8020 CONSTITUTION PL NE
Practice Address - Street 2:SUITE 202
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7607
Practice Address - Country:US
Practice Address - Phone:505-998-3096
Practice Address - Fax:505-998-3100
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1816-142085R0202X
TN024772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1031301272OtherMEDICARE