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NPI Code Detail

MEDICARE: MELISSA M VANTASSEL M.D.

MEDICARE: MELISSA M VANTASSEL 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
1207Q00000XFamily Medicine Physician60180416WA
2207Q00000XFamily Medicine Physician38267CO

Other Identifiers

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

General Provider Information

NPI Number : 1518940931
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA M VANTASSEL M.D.
Provider Business Mailing Address
First Line : 1200 112TH AVE NE STE C160
Second Line :
City : BELLEVUE
State : WA
Zip : 98004-3742
Country : US
Telephone Number : 425-453-1039
Fax Number : 425-453-8955
Provider Business Practice Location Address
First Line : 1200 112TH AVE NE STE C160
Second Line :
City : BELLEVUE
State : WA
Zip : 98004-3742
Country : US
Telephone Number : 425-453-1039
Fax Number : 425-453-8955
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2005
Last Update Date : 04/18/2018

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Directions to “ MELISSA M VANTASSEL M.D.” Practice Location

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