Provider Demographics
NPI:1447252697
Name:MELA, ANTHONY J SR (DO)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:MELA
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:10990 STATE ROUTE 61
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851-2575
Practice Address - Country:US
Practice Address - Phone:570-554-9260
Practice Address - Fax:570-554-9261
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2020-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS010569L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001856194Medicaid
PA113885Medicare PIN
PA001856194Medicaid