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General NPI Number Information
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NPI Number | 1881135697
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Entity Type | Organization
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Legal Business Name | SUSAN JOY MELLER DO PC
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 610 YORK RD STE 70
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City | JENKINTOWN
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State | PA
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Zip | 19046-2837
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Country | US
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Telephone | 215-827-0412
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Fax |
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Provider Business Mailing Address
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Address Line | 415 CHAPEL RD
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City | ELKINS PARK
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State | PA
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Zip | 19027-2504
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Country | US
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Telephone | 215-827-0412
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SUSAN JOY MELLER
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Credential | DO
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Telephone | 215-827-0412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS012125
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS012125
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License Number State | PA
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