Provider Demographics
NPI:1376065847
Name:CHORVAT, MELANIE ANNE (PA)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:ANNE
Last Name:CHORVAT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:MELANIE
Other - Middle Name:ANNE
Other - Last Name:HACKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1084 INDUSTRIAL PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-3725
Mailing Address - Country:US
Mailing Address - Phone:251-675-5034
Mailing Address - Fax:251-675-8511
Practice Address - Street 1:1084 INDUSTRIAL PKWY STE C
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-3725
Practice Address - Country:US
Practice Address - Phone:251-675-5034
Practice Address - Fax:251-675-8511
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL260388923OtherTIN