Healthcare Provider Details

I. General information

NPI: 1851377154
Provider Name (Legal Business Name): MELANIE J MARIEN RPA C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 PARK CLUB LN STE 100
WILLIAMSVILLE NY
14221-5263
US

IV. Provider business mailing address

550 ORCHARD PARK RD STE A105
WEST SENECA NY
14224-2646
US

V. Phone/Fax

Practice location:
  • Phone: 716-839-9402
  • Fax: 716-839-3570
Mailing address:
  • Phone: 716-677-6000
  • Fax: 716-677-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number006802 1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: