Provider Demographics
NPI:1558359836
Name:RESSLER, MELVIN WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:WAYNE
Last Name:RESSLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 HOSPITAL AVE 301
Mailing Address - Street 2:
Mailing Address - City:DUBOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1465
Mailing Address - Country:US
Mailing Address - Phone:814-375-4000
Mailing Address - Fax:
Practice Address - Street 1:7554 HOSPITAL DR
Practice Address - Street 2:SUITE 303
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-4178
Practice Address - Country:US
Practice Address - Phone:804-693-3400
Practice Address - Fax:804-693-9793
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101228441208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG03105Medicare UPIN
VA1558359836Medicaid
VA018344R53Medicare PIN
VA020048304Medicare PIN