MEDICARE: DR. ALAN M MERMELSTEIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	MD033183E	PA

General Provider Information

NPI Number	:	1073520458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN M MERMELSTEIN MD

Provider Business Mailing Address
First Line	:	7439 FRANKFORD AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19136
Country	:	US
Telephone Number	:	215-333-1377
Fax Number	:	215-333-1399

Provider Business Practice Location Address
First Line	:	7439 FRANKFORD AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19136
Country	:	US
Telephone Number	:	215-333-1377
Fax Number	:	215-333-1399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	09/14/2010

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