Provider Demographics
NPI:1760432264
Name:MELLMAN, DONALD LEWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LEWIN
Last Name:MELLMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:15164 MORENO BEACH DR.
Mailing Address - Street 2:APT. 1522
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555
Mailing Address - Country:US
Mailing Address - Phone:970-371-2861
Mailing Address - Fax:813-354-3623
Practice Address - Street 1:1149 SHIPWATCH CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5786
Practice Address - Country:US
Practice Address - Phone:813-205-2702
Practice Address - Fax:813-354-3623
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 22145207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD53727Medicare UPIN