Provider Demographics
NPI:1104876242
Name:GRAULE, MELISSA J (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:GRAULE
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 1:95 HIGHLAND AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-9483
Mailing Address - Country:US
Mailing Address - Phone:610-868-1100
Mailing Address - Fax:610-868-1111
Practice Address - Street 1:72 W JIMMIE LEEDS RD
Practice Address - Street 2:SUITE 1100
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9406
Practice Address - Country:US
Practice Address - Phone:609-677-9729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA080133002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0097381Medicaid
NJP00793706OtherRAILROAD MEDICARE
NJP00847779OtherRAILROAD MEDICARE
NJP00401588OtherRAILROAD MEDICARE
NJP00847779OtherRAILROAD MEDICARE
NJ0097381Medicaid
NJ099981ZDDPMedicare PIN
NJ099981AMLMedicare PIN