Provider Demographics
NPI:1013975366
Name:MADARANG, MELCHOR (MD)
Entity Type:Individual
Prefix:
First Name:MELCHOR
Middle Name:
Last Name:MADARANG
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 1:1580 SANTA BARBARA BLVD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6827
Mailing Address - Country:US
Mailing Address - Phone:352-259-2159
Mailing Address - Fax:352-259-5731
Practice Address - Street 1:1580 SANTA BARBARA BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-6827
Practice Address - Country:US
Practice Address - Phone:352-259-2159
Practice Address - Fax:352-259-5731
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059223207Q00000X, 207RI0200X
NJ25MA07398100207RI0200X
FLME122301207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0105392Medicaid
FL014115300Medicaid
MD400080300Medicaid
FLIB137ZOtherMEDICARE PTAN
MDH72381Medicare UPIN
MD400080300Medicaid
NJ107874V6AMedicare PIN