Provider Demographics
NPI:1689680738
Name:MELLINGER, RICHARD W (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:MELLINGER
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 1:446 N READING RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-9802
Mailing Address - Country:US
Mailing Address - Phone:717-733-6546
Mailing Address - Fax:717-733-6010
Practice Address - Street 1:446 N READING RD
Practice Address - Street 2:SUITE 301
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-9802
Practice Address - Country:US
Practice Address - Phone:717-733-6546
Practice Address - Fax:717-733-6010
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016027E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50051214OtherCAPITAL BLUE
PA161468OtherFREEDOM BLUE
PAP00261140 -GRPDD6938OtherRAILROAD MEDICARE
PA0650990Medicaid
PA161468OtherBLUE SHIELD
PAP002456OtherGATEWAY ASSURED
PAP002456OtherGATEWAY
PAB40337Medicare UPIN
PA0650990Medicaid