Provider Demographics
NPI:1811973464
Name:POWELL, MELANIE ANN (DO)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:POWELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:ANN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:3242 ROUTE 206 STE A2
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-4517
Practice Address - Country:US
Practice Address - Phone:609-298-4340
Practice Address - Fax:609-298-4370
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013108207Q00000X
NJ25MB07322800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30021765OtherKEYSTONE MERCY HEALTH
PAP00258118OtherRAIL ROAD MEDICARE
PA11316OtherBRAVO HEALTH
PA3689108OtherAETNA HMO
PA1625078OtherHIGHMARK BLUE SHIELD
PA7884513OtherAETNA PPO
PA101692254Medicaid
PA450480OtherCOVENTRY HEALTH AMERICA
PA3Y7157OtherHEALTH NET
PA2301780000OtherINDEPENDENCE BLUE CROSS
PA3Y7157OtherHEALTH NET
PA2301780000OtherINDEPENDENCE BLUE CROSS