Provider Demographics
NPI:1154528362
Name:MONDELLO, MELISSA (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:MONDELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-1204
Mailing Address - Country:US
Mailing Address - Phone:152-441-5670
Mailing Address - Fax:215-441-5661
Practice Address - Street 1:483 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-1204
Practice Address - Country:US
Practice Address - Phone:215-441-5670
Practice Address - Fax:215-441-5661
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2024-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT77525208000000X
NJ25MA11241200208000000X
PAMD439223208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics