Provider Demographics
NPI:1851330450
Name:MARTIN, MELANIE COWAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:COWAN
Last Name:MARTIN
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 1:8200 FLOURTOWN AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038-7976
Mailing Address - Country:US
Mailing Address - Phone:215-836-2500
Mailing Address - Fax:215-836-2502
Practice Address - Street 1:8200 FLOURTOWN AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-7976
Practice Address - Country:US
Practice Address - Phone:215-836-2500
Practice Address - Fax:215-836-2502
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030192E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0106544000OtherINDEPENDENCE BLUE CROSS
PA458935Medicare ID - Type Unspecified