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:
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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:610-446-2260
Mailing Address - Fax:610-446-3360
Practice Address - Street 1:1098 W BALTIMORE PIKE STE 3407
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5139
Practice Address - Country:US
Practice Address - Phone:610-566-7127
Practice Address - Fax:610-566-0793
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033859E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000 1930655OtherUNITED HEALTHCARE
PA1151931OtherAETNA HMO
PA2632612000OtherKEYSTONE
PA524894OtherMEDICARE GROUP NUMBER
PA2632612000OtherKEYSTONE
PAE55496Medicare UPIN