Provider Demographics
NPI:1538613138
Name:KARAM-MELL, MARIANNE J (PA-C)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:J
Last Name:KARAM-MELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:J
Other - Last Name:MELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-743-2100
Mailing Address - Fax:
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-743-2100
Practice Address - Fax:210-702-6215
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10714363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX362118701Medicaid
TX362118702OtherCSHCN
TX362118702OtherCSHCN