Provider Demographics
NPI:1548261936
Name:JEWELL, MELANIE (MD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:JEWELL
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 1:3 CRESCENT DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19112-1016
Mailing Address - Country:US
Mailing Address - Phone:215-503-3300
Mailing Address - Fax:215-503-3321
Practice Address - Street 1:3 CRESCENT DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19112-1016
Practice Address - Country:US
Practice Address - Phone:215-503-3300
Practice Address - Fax:215-503-3321
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029837E207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001001156Medicaid
B33608Medicare UPIN
PA027693PAGMedicare PIN
PA027693F6WMedicare PIN