Provider Demographics
NPI:1144601097
Name:MELLEN, PHOEBE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:LYNN
Last Name:MELLEN
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 1:840 WALNUT ST STE 1230
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5109
Mailing Address - Country:US
Mailing Address - Phone:215-928-3041
Mailing Address - Fax:215-928-3225
Practice Address - Street 1:840 WALNUT ST STE 1230
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5109
Practice Address - Country:US
Practice Address - Phone:215-928-3041
Practice Address - Fax:215-928-3225
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD466786207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology