MEDICARE: KAYLIE G MELIKER PA-C

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	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1336642586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLIE G MELIKER PA-C

Provider Business Mailing Address
First Line	:	110 OLD PADONIA RD STE 201
Second Line	:
City	:	COCKEYSVILLE
State	:	MD
Zip	:	21030-4949
Country	:	US
Telephone Number	:	443-761-6570
Fax Number	:	410-337-5134

Provider Business Practice Location Address
First Line	:	3401 BOX HILL CORPORATE CENTER DR STE 204
Second Line	:
City	:	ABINGDON
State	:	MD
Zip	:	21009-1200
Country	:	US
Telephone Number	:	410-836-8667
Fax Number	:	410-836-8996

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

Provider Enumeration Date	:	03/14/2018
Last Update Date	:	05/01/2023

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