Healthcare Provider Details

I. General information

NPI: 1821345299
Provider Name (Legal Business Name): MELISSA SCHMECK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2012
Last Update Date: 08/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 IROQUOIS AVE
SINKING SPRING PA
19608-1640
US

IV. Provider business mailing address

3332 ROSEDALE AVE
LAURELDALE PA
19605-2623
US

V. Phone/Fax

Practice location:
  • Phone: 610-670-0180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberRTO000138
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: