MEDICARE: DR. ANDREW LEE 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	207RR0500X	Rheumatology Physician	MD061891L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	960047	OTHER	PA	BLUE SHIELD
2	0416013000	OTHER	PA	PERSONAL CHOICE
3	2584	OTHER	PA	AETNA
4	0416013000	OTHER	PA	KEYSTONE

General Provider Information

NPI Number	:	1215920335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW LEE MERMELSTEIN MD

Provider Business Mailing Address
First Line	:	170 W GERMANTOWN PIKE
Second Line	:	SUITE C-2
City	:	EAST NORRITON
State	:	PA
Zip	:	19401-1389
Country	:	US
Telephone Number	:	610-277-2750
Fax Number	:	610-277-7949

Provider Business Practice Location Address
First Line	:	170 W. GERMANTOWN PIKE
Second Line	:	SUITE C-2
City	:	EAST NORRITON
State	:	PA
Zip	:	19401-1389
Country	:	US
Telephone Number	:	610-277-2750
Fax Number	:	610-277-7949

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	11/29/2007

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