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General NPI Number Information
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NPI Number | 1700997871
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Entity Type | Organization
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Legal Business Name | DELAND FAMILY MEDICINE PA
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 1450 S WOODLAND BLVD SUITE 300C
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City | DELAND
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State | FL
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Zip | 32720-7767
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Country | US
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Telephone | 386-740-1701
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Fax | 386-740-1798
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Provider Business Mailing Address
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Address Line | PO BOX 741240
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City | ORANGE CITY
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State | FL
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Zip | 32774-1240
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Country | US
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Telephone | 386-774-5211
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MELANIE R VANDEMARK
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Credential | MD
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Telephone | 386-740-1701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME912900
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License Number State | FL
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