Provider Demographics
NPI:1023193018
Name:MARC A. MELSER, MD, PL
Entity Type:Organization
Organization Name:MARC A. MELSER, MD, PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:MELSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-235-7281
Mailing Address - Street 1:3410 TAMIAMI TRL
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8112
Mailing Address - Country:US
Mailing Address - Phone:941-235-7281
Mailing Address - Fax:941-235-0463
Practice Address - Street 1:3410 TAMIAMI TRL
Practice Address - Street 2:SUITE 4
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8112
Practice Address - Country:US
Practice Address - Phone:941-235-7281
Practice Address - Fax:941-235-0463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7978351002OtherCIGNA
FL280495OtherWELLCARE
FLDC4107OtherRR MEDICARE
FL3648401OtherAETNA
FL25222OtherBC/BS FL
FL7978351002OtherCIGNA
FL280495OtherWELLCARE