Basic Information
| Provider Information | |||||||||
| NPI: | 1003882978 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ICASIANO | ||||||||
| FirstName: | MELODIE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 LANCASTER AVE | ||||||||
| Address2: | MOB EAST SUITE 158 | ||||||||
| City: | WYNNEWOOD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190963427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106492126 | ||||||||
| FaxNumber: | 6106427814 | ||||||||
| Practice Location | |||||||||
| Address1: | MADIGAN ARMY MEDICAL CENTER | ||||||||
| Address2: | BLDG 9040 FITZSIMMONS DR. | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539681740 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 04/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD00042886 | WA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.