Basic Information
| Provider Information | |||||||||
| NPI: | 1366605180 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERNANDEZ BRANDT | ||||||||
| FirstName: | MELINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1220 CREASE ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191253902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6463129036 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 255 W LANCASTER AVE | ||||||||
| Address2: | |||||||||
| City: | PAOLI | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193011763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845651000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2008 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | M-11397 | ID | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 25MA11066600 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD434479 | PA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | MD434479 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1022607630003 | 05 | PA | MEDICAID | 2089028 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 3713526000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 1022607630001 | 05 | PA | MEDICAID | P000805685 | 01 | PA | RR MEDICARE | OTHER | 1022607630002 | 05 | PA | MEDICAID | 30067974 | 01 | PA | KEYSTONE MERCY HEALTH PLAN | OTHER |