Provider Demographics
NPI:1598935447
Name:MELVIN I. ROAT, MD, LLC
Entity Type:Organization
Organization Name:MELVIN I. ROAT, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:I
Authorized Official - Last Name:ROAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-645-5755
Mailing Address - Street 1:1019 STANFORD DR
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2031
Mailing Address - Country:US
Mailing Address - Phone:610-645-5755
Mailing Address - Fax:610-645-0264
Practice Address - Street 1:100 E LANCASTER AVE STE 430
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3426
Practice Address - Country:US
Practice Address - Phone:610-645-5755
Practice Address - Fax:610-566-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033859E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000 193065510OtherUNITED HEALTHCARE
PA2632612000OtherKEYSTONE
PA1151931OtherAETNA HMO
PAE55496Medicare UPIN
PA2632612000OtherKEYSTONE