Healthcare Provider Details

I. General information

NPI: 1811973464
Provider Name (Legal Business Name): MELANIE ANN POWELL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE ANN WILLIAMS DO

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3242 ROUTE 206 STE A2
BORDENTOWN NJ
08505-4517
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 609-298-4340
  • Fax: 609-298-4370
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS013108
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB07322800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: