Provider Demographics
NPI:1114908050
Name:MELLER, MENACHEM (MD)
Entity Type:Individual
Prefix:DR
First Name:MENACHEM
Middle Name:
Last Name:MELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2007
Mailing Address - Country:US
Mailing Address - Phone:610-567-6964
Mailing Address - Fax:610-567-6170
Practice Address - Street 1:501 S 54TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1900
Practice Address - Country:US
Practice Address - Phone:215-748-9822
Practice Address - Fax:215-748-9717
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042497207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4292965OtherAETNA HMO
PA30002020OtherKMHP
PA2957202OtherAETNA HMO
PA721863OtherBLUE SHIELD
PA0012802120016Medicaid
PA0559166000OtherKEYSTONE HEALTH PLAN EAST
PA7375879OtherCIGNA
PA0559166000OtherKEYSTONE HEALTH PLAN EAST
PA2957202OtherAETNA HMO