Provider Demographics
NPI:1215920335
Name:MERMELSTEIN, ANDREW LEE (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LEE
Last Name:MERMELSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:170 W GERMANTOWN PIKE
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1389
Mailing Address - Country:US
Mailing Address - Phone:610-277-2750
Mailing Address - Fax:610-277-7949
Practice Address - Street 1:170 W. GERMANTOWN PIKE
Practice Address - Street 2:SUITE C-2
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1389
Practice Address - Country:US
Practice Address - Phone:610-277-2750
Practice Address - Fax:610-277-7949
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061891L207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA960047OtherBLUE SHIELD
PA0416013000OtherPERSONAL CHOICE
PA2584OtherAETNA
PA0416013000OtherKEYSTONE
PA2584OtherAETNA
PA960047GQTMedicare PIN