Provider Demographics
NPI:1881681278
Name:ROAT, MELVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:
Last Name:ROAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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:610-566-1744
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033859E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1151931OtherAETNA HMO
PA0000 1930655OtherUNITED HEALTHCARE
PA524894OtherMEDICARE GROUP NUMBER
PA2632612000OtherKEYSTONE
PA2632612000OtherKEYSTONE
PAE55496Medicare UPIN