Provider Demographics
NPI:1023096062
Name:MELCHIORRE, LOUIS P JR (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:P
Last Name:MELCHIORRE
Suffix:JR
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 1:401 ROUTE 73 N STE 320
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3426
Mailing Address - Country:US
Mailing Address - Phone:856-879-2887
Mailing Address - Fax:844-778-8941
Practice Address - Street 1:646 KINGS HWY
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3145
Practice Address - Country:US
Practice Address - Phone:856-879-2887
Practice Address - Fax:844-778-8941
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06561800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7634706Medicaid
I43179Medicare UPIN
NJ7634706Medicaid