Provider Demographics
NPI:1598754103
Name:MELILLO, ANTHONY STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:STEPHEN
Last Name:MELILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1051 PINELOCH DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2742
Mailing Address - Country:US
Mailing Address - Phone:281-286-3500
Mailing Address - Fax:281-286-3553
Practice Address - Street 1:1051 PINELOCH DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-2742
Practice Address - Country:US
Practice Address - Phone:281-286-3500
Practice Address - Fax:281-286-3553
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ8057207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG11596Medicare UPIN
TX6411530001Medicare NSC
TX00492JMedicare PIN