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General NPI Number Information
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NPI Number | 1720062235
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Entity Type | Individual
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Provider Name | MELANIE C. FREDERICK MD
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Gender | Female
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 11851 SE LOOP 410
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City | SAN ANTONIO
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State | TX
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Zip | 78221-4214
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Country | US
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Telephone | 210-465-9592
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Fax | 210-479-2010
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Provider Business Mailing Address
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Address Line | 3503 PAESANOS PKWY STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78231-1225
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Country | US
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Telephone | 210-492-8922
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Fax | 210-479-2010
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | T3082
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License Number State | TX
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