{
"Npi": {
"NPI": "1003882978",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ICASIANO",
"FirstName": "MELODIE",
"MiddleName": "M",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "100 LANCASTER AVE",
"SecondLineMailingAddress": "MOB EAST SUITE 158",
"MailingAddressCityName": "WYNNEWOOD",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19096-3427",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "610-649-2126",
"MailingAddressFaxNumber": "610-642-7814",
"FirstLinePracticeLocationAddress": "MADIGAN ARMY MEDICAL CENTER",
"SecondLinePracticeLocationAddress": "BLDG 9040 FITZSIMMONS DR.",
"PracticeLocationAddressCityName": "TACOMA",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98431-0001",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "253-968-1740",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/28/2006",
"LastUpdateDate": "04/22/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207V00000X",
"TaxonomyName": "Obstetrics & Gynecology Physician",
"LicenseNumber": "MD00042886",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}