Healthcare Provider Details

I. General information

NPI: 1871572362
Provider Name (Legal Business Name): MELISSA M RENDLEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA FORRET RENDLEN DO

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 SOLAREX CT
FREDERICK MD
21703-8624
US

IV. Provider business mailing address

610 SOLAREX CT
FREDERICK MD
21703-8624
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-6162
  • Fax:
Mailing address:
  • Phone: 301-663-6162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number69199
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036118777
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0103748
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: