Provider Demographics
NPI:1598756991
Name:MELLORS, ROBERT C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:MELLORS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 LONGWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1683
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:781-871-2940
Practice Address - Street 1:143 LONGWATER DR
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1683
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:781-878-6750
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0195332Medicaid
MA042297845OtherHCVM
MA700417OtherTUFTS
MAC04862OtherBCBS
MA0019261OtherNEIGHBORHOOD HLTH PLAN
MA042297845OtherTRICARE
MA7613316OtherAETNA
MA042297845OtherUNITED HEALTH CARE
MA042297845OtherGIC UNICARE
MA042297845OtherPRIVATE HEALTHCARE SYSTEM
MAB10182106OtherCIGNA
MA45684OtherFALLON
MA61736OtherHVD PILGRIM HEALTH CARE
MAB10182101OtherCIGNA INT
MAB10182106OtherCIGNA
MA0195332Medicaid
MAD94048Medicare UPIN
MA0195332Medicaid