Provider Demographics
NPI:1932172590
Name:BENTZ, MELANIE R (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:R
Last Name:BENTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MELANIE
Other - Middle Name:R
Other - Last Name:BOWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2315 MYRTLE STREET
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-4604
Mailing Address - Country:US
Mailing Address - Phone:814-453-7767
Mailing Address - Fax:814-455-3937
Practice Address - Street 1:2315 MYRTLE STREET
Practice Address - Street 2:SUITE 190
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-4604
Practice Address - Country:US
Practice Address - Phone:814-453-7767
Practice Address - Fax:814-455-3937
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051457363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ14910Medicare UPIN
PAQ14910Medicare UPIN
PA078679Medicare ID - Type Unspecified