Provider Demographics
NPI:1033469580
Name:BETZ, MELANIE N (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:N
Last Name:BETZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:N
Other - Last Name:SCHWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4940 EASTERN AVE
Mailing Address - Street 2:A1 EAST / SUITE A-150
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2735
Mailing Address - Country:US
Mailing Address - Phone:410-550-7852
Mailing Address - Fax:410-550-0178
Practice Address - Street 1:4940 EASTERN AVE
Practice Address - Street 2:A1 EAST / SUITE A-150
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2735
Practice Address - Country:US
Practice Address - Phone:410-550-7852
Practice Address - Fax:410-550-0178
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004846363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant