Provider Demographics
NPI:1407045032
Name:MELANIE MENCER, M.D., P.A.
Entity Type:Organization
Organization Name:MELANIE MENCER, M.D., P.A.
Other - Org Name:SYNERGY MEDICAL & WELLNESS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:MENCER
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-522-1221
Mailing Address - Street 1:1213 HERMANN DR
Mailing Address - Street 2:SUITE 430
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7018
Mailing Address - Country:US
Mailing Address - Phone:713-522-1221
Mailing Address - Fax:713-522-1210
Practice Address - Street 1:1213 HERMANN DR
Practice Address - Street 2:SUITE 430
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7018
Practice Address - Country:US
Practice Address - Phone:713-522-1221
Practice Address - Fax:713-522-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7454207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166891501Medicaid
TX00736WMedicare PIN
TXH27651Medicare UPIN