1578533089 NPI number — SUSAN A MELLINGER MD

Table of content: SUSAN A MELLINGER MD (NPI 1578533089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578533089 NPI number — SUSAN A MELLINGER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MELLINGER
Provider First Name:
SUSAN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578533089
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
317 CHESTNUT STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUARRYVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-786-7383
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
317 CHESTNUT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUARRYVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-786-7383
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD020977E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 953079 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: G45819 . This is a "HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7147222 . This is a "AETNA NON-HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 080111446 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2530725 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50090588 . This is a "CAPITAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0016500910005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 55194 S101 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P002672 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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