Provider Demographics
NPI:1164427894
Name:MELTZER, ALAN JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JAY
Last Name:MELTZER
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 1:2110 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6596
Mailing Address - Country:US
Mailing Address - Phone:215-537-4900
Mailing Address - Fax:215-546-9518
Practice Address - Street 1:2110 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19103-6596
Practice Address - Country:US
Practice Address - Phone:215-537-4900
Practice Address - Fax:215-546-9518
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015378E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00571340Medicaid
PAB36681Medicare UPIN
PA106241Medicare ID - Type Unspecified