Individual
MRS. MELORA R JONES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A-C
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-5030
(215) 707-3494
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(215) 707-5030
(215) 707-3494
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA052742
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100727800
MEDICAID GROUP TPI
PA
05
—
1417030164
—
PA
01
—
597586
MEDICARE GROUP TPI
PA
01
—
CD4829
RR MEDICARE GROUP TPI
PA
Enumeration date
10/23/2006
Last updated
04/24/2018
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