Provider Demographics
NPI:1609870567
Name:MEHLE, ANTHONY L (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:L
Last Name:MEHLE
Suffix:
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 1:960 WINDHAM CT
Mailing Address - Street 2:STE 2
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5087
Mailing Address - Country:US
Mailing Address - Phone:330-758-8866
Mailing Address - Fax:330-758-4051
Practice Address - Street 1:960 WINDHAM CT
Practice Address - Street 2:STE 2
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-5087
Practice Address - Country:US
Practice Address - Phone:330-758-8866
Practice Address - Fax:330-758-4051
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
OH35-05-9099207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0784594Medicaid
OHME0666913Medicare ID - Type Unspecified
OHE50080Medicare UPIN