Provider Demographics
NPI:1518997675
Name:COGNETTI, MELISSA R (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:COGNETTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:REIMEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:860 1ST AVE
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406
Mailing Address - Country:US
Mailing Address - Phone:610-265-1251
Mailing Address - Fax:610-265-1252
Practice Address - Street 1:860 1ST AVE
Practice Address - Street 2:SUITE 4B
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406
Practice Address - Country:US
Practice Address - Phone:610-265-1251
Practice Address - Fax:610-265-1252
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426028207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013027240001Medicaid
PA1013027240002Medicaid
PA1013027240001Medicaid
PA1013027240002Medicaid