Healthcare Provider Details

I. General information

NPI: 1538177316
Provider Name (Legal Business Name): SUSAN MELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 KAHLE DR UNIT L
STATELINE NV
89449-9807
US

IV. Provider business mailing address

415 CHAPEL RD
ELKINS PARK PA
19027-2504
US

V. Phone/Fax

Practice location:
  • Phone: 215-287-0412
  • Fax:
Mailing address:
  • Phone: 215-287-0412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number91285
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO3045
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS18229
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02006612A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number17892
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberT4557
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB11418600
License Number StateNJ
# 8
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS012125
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: