Provider Demographics
NPI:1861636649
Name:MOPE, MELODIE J (MD)
Entity Type:Individual
Prefix:DR
First Name:MELODIE
Middle Name:J
Last Name:MOPE
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 1:5151 WINTER GARDEN VINELAND RD
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6098
Mailing Address - Country:US
Mailing Address - Phone:407-635-3070
Mailing Address - Fax:407-636-7802
Practice Address - Street 1:5151 WINTER GARDEN VINELAND RD
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6098
Practice Address - Country:US
Practice Address - Phone:407-635-3070
Practice Address - Fax:407-636-7802
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007626000Medicaid
FLGR081YMedicare PIN