Provider Demographics
NPI:1851377154
Name:MARIEN, MELANIE J (RPA C)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:J
Last Name:MARIEN
Suffix:
Gender:F
Credentials:RPA C
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Mailing Address - Street 1:550 ORCHARD PARK RD
Mailing Address - Street 2:STE A105
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2646
Mailing Address - Country:US
Mailing Address - Phone:716-677-6000
Mailing Address - Fax:716-677-6006
Practice Address - Street 1:180 PARK CLUB LN
Practice Address - Street 2:STE 100
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5263
Practice Address - Country:US
Practice Address - Phone:716-839-9402
Practice Address - Fax:716-839-3570
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY006802 1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00026522501OtherUNIVERA HEALTHCARE
NY9511989OtherINDEPENDENT HEALTH
NY02107399Medicaid
NY000570154002OtherBLUE CROSS BLUE SHIELD
00026522501OtherUNIVERA HEALTHCARE
NY000570154002OtherBLUE CROSS BLUE SHIELD