Provider Demographics
NPI:1881604726
Name:KING, MELODY O (MD)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:O
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:K
Other - Last Name:ORR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-9358
Mailing Address - Fax:321-434-9521
Practice Address - Street 1:8745 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-5997
Practice Address - Country:US
Practice Address - Phone:321-434-9358
Practice Address - Fax:321-434-9521
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01911207R00000X
FLME110293208M00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003693100Medicaid
FL14E6COtherFLORIDA BLUE
FLFC018YOtherMEDICARE
9877194OtherAETNA PROVIDER #
FLP01275461OtherRRMR
FLFC018YOtherMEDICARE
NC2073338Medicare PIN
FL14E6COtherFLORIDA BLUE
NC5911514Medicaid