Provider Demographics
NPI:1972615722
Name:BROWN-DEMICHELE, MELANIE ANN (OD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:BROWN-DEMICHELE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2661 RIVA RD STE 1030
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7131
Mailing Address - Country:US
Mailing Address - Phone:410-571-8733
Mailing Address - Fax:410-571-6309
Practice Address - Street 1:10 1/2 S MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-1123
Practice Address - Country:US
Practice Address - Phone:570-403-1341
Practice Address - Fax:570-403-3062
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1803815Medicaid
410043417OtherRAILROAD MEDICARE
812005OtherFIRST PRIORITY HEALTH
BR607231OtherHIGH MARK BLUE SHIELD
59623OtherGEISINGER HEALTH PLAN
506554OtherAETNA
506554OtherAETNA
BR607231OtherHIGH MARK BLUE SHIELD