Provider Demographics
NPI:1275722241
Name:GILROY, MELISSA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:GILROY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:GILROY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1501 N CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2309
Mailing Address - Country:US
Mailing Address - Phone:610-821-2828
Mailing Address - Fax:610-821-7915
Practice Address - Street 1:1501 N CEDAR CREST BLVD
Practice Address - Street 2:SUITE110
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2309
Practice Address - Country:US
Practice Address - Phone:610-821-2828
Practice Address - Fax:610-821-7915
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055745363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA249040ES2Medicare PIN
PA106918Medicare PIN