Provider Demographics
NPI:1235469149
Name:BOUDWIN, MELODY JAN (PA)
Entity type:Individual
Prefix:MISS
First Name:MELODY
Middle Name:JAN
Last Name:BOUDWIN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:33 BROOK DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-3932
Mailing Address - Country:US
Mailing Address - Phone:856-461-1400
Mailing Address - Fax:856-461-2366
Practice Address - Street 1:8001 ROUTE 130
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-1870
Practice Address - Country:US
Practice Address - Phone:856-461-1400
Practice Address - Fax:856-461-2366
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2016-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00226700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant