Provider Demographics
NPI:1598765513
Name:DMELLO, RICHARD G (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:DMELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1312 PROFESSIONAL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-8007
Mailing Address - Country:US
Mailing Address - Phone:812-491-6419
Mailing Address - Fax:812-491-6465
Practice Address - Street 1:1312 PROFESSIONAL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-8007
Practice Address - Country:US
Practice Address - Phone:812-491-6419
Practice Address - Fax:812-491-6465
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01047609207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN3900088571OtherRAILROAD MEDICARE
IN7928408OtherAETNA
KY64063555Medicaid
IN200398050Medicaid
KY86207OtherCOVENTRY
IN200398050Medicaid
KY64063555Medicaid
KY392112Medicare PIN
IN267300AMedicare PIN