Provider Demographics
NPI:1063480085
Name:MELSER, MARC A (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:A
Last Name:MELSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:MANAGED CARE DEPT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:
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:33952-8127
Practice Address - Country:US
Practice Address - Phone:941-235-7281
Practice Address - Fax:941-235-0463
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065024208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375845100Medicaid
FL1193401OtherWELLCARE
FL334857OtherAVMED
FLP00699994OtherRAILROAD MEDICARE
FL5496020OtherAETNA
FLQMP000005122202OtherMOLINA HEALTHCARE
FL25222OtherBC/BS FL
FL5496020OtherAETNA
FLE50733Medicare UPIN
FLP00699994OtherRAILROAD MEDICARE
FL25222YMedicare PIN