Provider Demographics
NPI:1740482793
Name:MARS, MELANIE RAE SR (MAOTRL)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:RAE
Last Name:MARS
Suffix:SR
Gender:F
Credentials:MAOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 WILMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-2526
Mailing Address - Country:US
Mailing Address - Phone:724-656-2930
Mailing Address - Fax:
Practice Address - Street 1:1405 WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-2526
Practice Address - Country:US
Practice Address - Phone:724-656-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA18927530004Medicaid