Healthcare Provider Details

I. General information

NPI: 1083343313
Provider Name (Legal Business Name): MELAT TIRUNEH WORKU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

487 E MOORESTOWN RD
WIND GAP PA
18091-9662
US

IV. Provider business mailing address

487 E MOORESTOWN RD STE 106
WIND GAP PA
18091-9683
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-7474
  • Fax:
Mailing address:
  • Phone: 484-526-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMT226984
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: