MEDICARE: MELANIE VETTIMATTAM MD

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	207Q00000X	Family Medicine Physician	R1472	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265848782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE VETTIMATTAM MD

Provider Business Mailing Address
First Line	:	4230 W GREEN OAKS BLVD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-4517
Country	:	US
Telephone Number	:	817-200-7533
Fax Number	:	817-476-6051

Provider Business Practice Location Address
First Line	:	4230 W GREEN OAKS BLVD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-4517
Country	:	US
Telephone Number	:	817-200-7533
Fax Number	:	817-476-6051

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

Provider Enumeration Date	:	07/03/2014
Last Update Date	:	01/15/2026

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Directions to “ MELANIE VETTIMATTAM MD” Practice Location

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