Provider Demographics
NPI:1790867281
Name:MELLEMA, RITA H (MD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:H
Last Name:MELLEMA
Suffix:
Gender:F
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:PO BOX 34640
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1640
Mailing Address - Country:US
Mailing Address - Phone:509-458-5800
Mailing Address - Fax:509-473-4050
Practice Address - Street 1:800 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2803
Practice Address - Country:US
Practice Address - Phone:509-458-5800
Practice Address - Fax:509-473-4050
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030683207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8146839Medicaid
WAG8876219Medicare PIN
WAGAB03863Medicare PIN
WAF39605Medicare UPIN