Provider Demographics
NPI:1578533089
Name:MELLINGER, SUSAN A (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:MELLINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:QUARRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17566
Mailing Address - Country:US
Mailing Address - Phone:717-786-7383
Mailing Address - Fax:
Practice Address - Street 1:317 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:QUARRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:17566
Practice Address - Country:US
Practice Address - Phone:717-786-7383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020977E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA953079OtherHIGHMARK BLUE SHIELD
PAG45819OtherHEALTH ASSURANCE
PA7147222OtherAETNA NON-HMO
PA080111446OtherRAILROAD MEDICARE
PA2530725OtherAETNA HMO
50090588OtherCAPITAL
PA0016500910005Medicaid
PA55194 S101OtherGEISINGER HEALTH PLAN
PAP002672OtherGATEWAY HEALTH PLAN
PAG54819Medicare UPIN
PA0016500910005Medicaid