| Doctor Name: | DR. MELODIE M ICASIANO |
| NPI Number: | 1003882978 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | MD00042886 |
| Business Practice Address: | Madigan Army Medical Center Bldg 9040 Fitzsimmons Dr. Tacoma, WA - 984310001 |
| Business Phone Number: | 2539681740 |
| Business Fax Number: | |
| Mailing Address: | 100 Lancaster Ave, Mob East Suite 158 WYNNEWOOD |
| State: | PA |
| Postal Code: | 190963427 |
| Phone Number: | 6106492126 |
| Fax Number: | 6106427814 |
| NPI Enumeration Date: | 02/28/2006 |
| NPI Last Update Date: | 04/22/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | MD00042886 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |