MEDICARE: MELANIE R ANGELL R, PA-C

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	363AM0700X	Medical Physician Assistant	006778	NY

General Provider Information

NPI Number	:	1831137942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE R ANGELL R, PA-C

Provider Business Mailing Address
First Line	:	150 BROAD ST
Second Line	:
City	:	HAMILTON
State	:	NY
Zip	:	13346-9518
Country	:	US
Telephone Number	:	315-824-1100
Fax Number	:	315-495-7056

Provider Business Practice Location Address
First Line	:	5180 S MAIN ST
Second Line	:
City	:	MUNNSVILLE
State	:	NY
Zip	:	13409-4058
Country	:	US
Telephone Number	:	315-495-2690
Fax Number	:	315-495-7056

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	10/23/2024

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