Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD042497 | PA |
NPI | 1114908050 |
---|---|
Provider Name | Dr. Menachem Meller |
First Address | Conshohocken, PA 19428-2007 |
Second Address | Philadelphia, PA 19143-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 09/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012802120016 | (05) | PA |
0559166000 | KEYSTONE HEALTH PLAN EAST (01) | PA |
2957202 | AETNA HMO (01) | PA |
30002020 | KMHP (01) | PA |
4292965 | AETNA HMO (01) | PA |
721863 | BLUE SHIELD (01) | PA |
7375879 | CIGNA (01) | PA |