Provider Demographics
NPI:1275626558
Name:PALMER, MELONIE ROMINA (DPM)
Entity Type:Individual
Prefix:DR
First Name:MELONIE
Middle Name:ROMINA
Last Name:PALMER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BASSWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-1927
Mailing Address - Country:US
Mailing Address - Phone:302-792-1961
Mailing Address - Fax:302-792-1981
Practice Address - Street 1:1004 SOCIETY DR
Practice Address - Street 2:PALMER PODIATRY
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-1782
Practice Address - Country:US
Practice Address - Phone:302-792-1961
Practice Address - Fax:302-792-1981
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000131213E00000X
PASC003464R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0440231000OtherBLUE SHIELD HMO ID#
DE0000878817Medicaid
PA0440231000OtherBLUE SHIELD HMO ID#
DE0000878817Medicaid
U02192Medicare UPIN