Provider Demographics
NPI:1295222115
Name:SILLAH, MELVIN TITUS
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:TITUS
Last Name:SILLAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12803 GLASGOW CT
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-7034
Mailing Address - Country:US
Mailing Address - Phone:571-201-4177
Mailing Address - Fax:888-885-8581
Practice Address - Street 1:12803 GLASGOW CT
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-7034
Practice Address - Country:US
Practice Address - Phone:571-201-4177
Practice Address - Fax:888-885-8581
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR4177251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health