Provider Demographics
NPI:1407960396
Name:MELROSE PODIATRY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MELROSE PODIATRY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CHERELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-462-2610
Mailing Address - Street 1:1520 SNYDER AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADEPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145
Mailing Address - Country:US
Mailing Address - Phone:215-462-2610
Mailing Address - Fax:215-462-0445
Practice Address - Street 1:1520 SNYDER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-3937
Practice Address - Country:US
Practice Address - Phone:215-462-2610
Practice Address - Fax:215-462-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA623152OtherBLUE CROSS/BLUE SHIELD
PA0148848101Medicaid
PA0148848101Medicaid
PA4329140001Medicare NSC