Healthcare Provider Details

I. General information

NPI: 1427007921
Provider Name (Legal Business Name): MELANIE L CARDOZA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 MILLIKEN BLVD STE A
FALL RIVER MA
02721
US

IV. Provider business mailing address

211 MILLIKEN BLVD STE A
FALL RIVER MA
02721
US

V. Phone/Fax

Practice location:
  • Phone: 508-674-5200
  • Fax: 508-675-1719
Mailing address:
  • Phone: 508-674-5200
  • Fax: 508-675-1719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number217023
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9784888
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: