Provider Demographics
NPI:1881135697
Name:SUSAN JOY MELLER DO PC
Entity type:Organization
Organization Name:SUSAN JOY MELLER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:MELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-827-0412
Mailing Address - Street 1:415 CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2504
Mailing Address - Country:US
Mailing Address - Phone:215-827-0412
Mailing Address - Fax:
Practice Address - Street 1:610 YORK RD
Practice Address - Street 2:STE 70
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2837
Practice Address - Country:US
Practice Address - Phone:215-827-0412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012125207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty