Provider Demographics
NPI:1518184316
Name:MELENDEZ PACHECO, ENID ROSARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ENID
Middle Name:ROSARIO
Last Name:MELENDEZ PACHECO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:843 HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-7219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 MUNDY ST
Practice Address - Street 2:MAC IV BUILDING
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6830
Practice Address - Country:US
Practice Address - Phone:570-824-0930
Practice Address - Fax:570-824-7755
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD458396208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1518184316OtherGHP FAMILY
PA103223002-0001Medicaid
PA1518184316OtherGHP
PA50144202OtherCAPITAL BLUE CROSS
PA9886842OtherCIGNA
PA1518184316OtherUNITED HEALTH CARE
PA003433191OtherHIGHMARK BLUE SHIELD
PA30257285OtherAMERIHEALTH CARITAS
PA5397784OtherAETNA/COVENTRY
PA25-1645055OtherHUMANA/CHOICE CARE
PA25-1645055OtherAETNA BETTER HEALTH
PA25-1645055OtherHUMANA/CHOICE CARE
PRE63438Medicare UPIN