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NPI Code Detail

MEDICARE: MELANIE S ICE DO

MEDICARE: MELANIE S ICE DO
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
1207Q00000XFamily Medicine Physician05008097LPA
2207Q00000XFamily Medicine PhysicianOS008097LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417987579
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELANIE S ICE DO
Provider Business Mailing Address
First Line : 1055 ANDREW DR
Second Line : SUITE B
City : WEST CHESTER
State : PA
Zip : 19380-3446
Country : US
Telephone Number : 610-436-4448
Fax Number :
Provider Business Practice Location Address
First Line : 1055 ANDREW DR
Second Line : SUITE B
City : WEST CHESTER
State : PA
Zip : 19380-3446
Country : US
Telephone Number : 610-436-4448
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2006
Last Update Date : 01/05/2023

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Directions to “ MELANIE S ICE DO” Practice Location

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