Provider Demographics
NPI:1598097552
Name:SMEAD, MELINDA J (PA-C)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:J
Last Name:SMEAD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 MARKET ST
Mailing Address - Street 2:7 TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5545
Mailing Address - Country:US
Mailing Address - Phone:215-662-3340
Mailing Address - Fax:215-222-8875
Practice Address - Street 1:3737 MARKET ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5545
Practice Address - Country:US
Practice Address - Phone:215-662-3340
Practice Address - Fax:215-222-8875
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004134363A00000X
PAMA055974363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS567Medicare PIN
MDS576Medicare PIN