Provider Demographics
NPI:1730132978
Name:MELL, MATTHEW WILLIAM (MD, FACS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WILLIAM
Last Name:MELL
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PASTEUR DRIVE, H3600
Mailing Address - Street 2:STANFORD UNIVERSITY HOSPITAL AND CLINICS
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5642
Mailing Address - Country:US
Mailing Address - Phone:650-723-3639
Mailing Address - Fax:650-498-6044
Practice Address - Street 1:300 PASTEUR DRIVE, H3600
Practice Address - Street 2:STANFORD UNIVERSITY HOSPITAL AND CLINICS
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5642
Practice Address - Country:US
Practice Address - Phone:650-723-3639
Practice Address - Fax:650-498-6044
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0657582086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery