Provider Demographics
NPI:1073214060
Name:W. DAVID MELLO, M.D., INC.,A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:W. DAVID MELLO, M.D., INC.,A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/CFO
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:MELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-790-0122
Mailing Address - Street 1:1818 VERDUGO BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1400
Mailing Address - Country:US
Mailing Address - Phone:818-790-0122
Mailing Address - Fax:818-790-4623
Practice Address - Street 1:1818 VERDUGO BLVD STE 107
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1400
Practice Address - Country:US
Practice Address - Phone:818-790-0122
Practice Address - Fax:818-790-4623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty