MEDICARE: DR. MELANIE WACHTEL ROTENBERG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	ME 65926	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25259X	OTHER	FL	MEDICARE

General Provider Information

NPI Number	:	1124023866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELANIE WACHTEL ROTENBERG M.D.

Provider Business Mailing Address
First Line	:	PO BOX 61615
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32906-1615
Country	:	US
Telephone Number	:	321-327-2274
Fax Number	:	321-327-2848

Provider Business Practice Location Address
First Line	:	4650 LIPSCOMB ST NE
Second Line	:	SUITE 14
City	:	PALM BAY
State	:	FL
Zip	:	32905-2997
Country	:	US
Telephone Number	:	321-327-2274
Fax Number	:	321-327-2848

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2005
Last Update Date	:	09/19/2014

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