Provider Demographics
NPI:1740244755
Name:KOEHLER, MELANIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:A
Last Name:KOEHLER
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 1:143 N RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-1330
Mailing Address - Country:US
Mailing Address - Phone:706-451-9305
Mailing Address - Fax:
Practice Address - Street 1:143 N RAILROAD ST
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-1330
Practice Address - Country:US
Practice Address - Phone:570-645-1930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057285L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007423240006Medicaid
PA1007423240006Medicaid