Provider Demographics
NPI:1730151549
Name:VANDER STRATEN, MELODY RENE (MD)
Entity type:Individual
Prefix:DR
First Name:MELODY
Middle Name:RENE
Last Name:VANDER STRATEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:RENE
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12221 N MOPAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-681-5900
Mailing Address - Fax:512-681-5922
Practice Address - Street 1:5145 N FM 620 RANCH ROAD, BLDG I
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-1815
Practice Address - Country:US
Practice Address - Phone:512-681-5900
Practice Address - Fax:512-681-5922
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1393207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX334731201Medicaid
TX8BS530OtherBCBS
TXP01539122OtherRRMC PTAN
TX8M7132OtherBCBS OF TEXAS INDIVIDUAL #
TX8M7132OtherBCBS OF TEXAS INDIVIDUAL #
TX341838YY7ZMedicare PIN