Provider Demographics
NPI:1285676171
Name:MERMELSTEIN, NEAL IRA (DO)
Entity type:Individual
Prefix:
First Name:NEAL
Middle Name:IRA
Last Name:MERMELSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7439 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-3632
Mailing Address - Country:US
Mailing Address - Phone:215-333-9484
Mailing Address - Fax:215-333-7739
Practice Address - Street 1:7439 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-3632
Practice Address - Country:US
Practice Address - Phone:215-333-9484
Practice Address - Fax:215-333-7739
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005880L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011043040003Medicaid
PA0011043040003Medicaid
PAE06283Medicare UPIN