Healthcare Provider Details

I. General information

NPI: 1346688793
Provider Name (Legal Business Name): MELINA ELPI MARMARELIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD 2 WEST
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

3400 CIVIC CENTER BLVD 2 WEST
PHILADELPHIA PA
19104-5127
US

V. Phone/Fax

Practice location:
  • Phone: 215-615-0063
  • Fax: 215-349-8144
Mailing address:
  • Phone: 215-615-0063
  • Fax: 215-349-8144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number255530
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD464989
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: