Provider Demographics
NPI:1639155286
Name:D'ADDEZIO, CARMELLA LOUISE (DO)
Entity Type:Individual
Prefix:DR
First Name:CARMELLA
Middle Name:LOUISE
Last Name:D'ADDEZIO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CARMELLA
Other - Middle Name:LOUISE
Other - Last Name:D'ADDEZIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:149 HART STREET
Mailing Address - Street 2:INTERNAL MEDICINE CLINIC
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76311-3478
Mailing Address - Country:US
Mailing Address - Phone:940-676-4472
Mailing Address - Fax:940-676-8005
Practice Address - Street 1:149 HART ST
Practice Address - Street 2:82 MDG/SGOP
Practice Address - City:SHEPPARD AFB
Practice Address - State:TX
Practice Address - Zip Code:76311-3478
Practice Address - Country:US
Practice Address - Phone:940-676-4472
Practice Address - Fax:950-676-8005
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007141207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology