MEDICARE: DR. MELANIE RAE PICKERING DO

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	2085R0202X	Diagnostic Radiology Physician	A-1816-14	NM
2	2085R0202X	Diagnostic Radiology Physician	02477	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1031301272	OTHER		MEDICARE

General Provider Information

NPI Number	:	1588838031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELANIE RAE PICKERING DO

Provider Business Mailing Address
First Line	:	8020 CONSTITUTION PL NE
Second Line	:	SUITE 202
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7607
Country	:	US
Telephone Number	:	505-998-3096
Fax Number	:	505-998-3100

Provider Business Practice Location Address
First Line	:	8020 CONSTITUTION PL NE
Second Line	:	SUITE 202
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7607
Country	:	US
Telephone Number	:	505-998-3096
Fax Number	:	505-998-3100

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

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	06/04/2014

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