Provider Demographics
NPI:1780248054
Name:RODRIGUEZ MELO, MARCO ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:MARCO
Middle Name:ANTONIO
Last Name:RODRIGUEZ MELO
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 1:210 FAIRVIEW AVE N APT 613
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-5396
Mailing Address - Country:US
Mailing Address - Phone:480-299-4683
Mailing Address - Fax:
Practice Address - Street 1:57 WATER ST
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614-5231
Practice Address - Country:US
Practice Address - Phone:207-374-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2022-07-28
Deactivation Date:2019-12-04
Deactivation Code:
Reactivation Date:2020-01-24
Provider Licenses
StateLicense IDTaxonomies
MEMD25341207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine