Provider Demographics
NPI:1730188301
Name:MONNIG, MELANIE (PA-C)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:MONNIG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 SILVERSIDE RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-1774
Mailing Address - Country:US
Mailing Address - Phone:302-798-0666
Mailing Address - Fax:302-798-2401
Practice Address - Street 1:2600 GLASGOW AVE
Practice Address - Street 2:SUITE 124
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-4773
Practice Address - Country:US
Practice Address - Phone:302-836-4200
Practice Address - Fax:302-836-8431
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000215363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001176543Medicaid
DE0001176543Medicaid
DE004740T76Medicare ID - Type Unspecified