Provider Demographics
NPI:1003241316
Name:MELLERSON, DARIEN ANTOINE (DPT)
Entity type:Individual
Prefix:
First Name:DARIEN
Middle Name:ANTOINE
Last Name:MELLERSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7556 TEAGUE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1213
Mailing Address - Country:US
Mailing Address - Phone:410-799-4994
Mailing Address - Fax:410-799-1044
Practice Address - Street 1:7556 TEAGUE RD STE 400
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1213
Practice Address - Country:US
Practice Address - Phone:410-799-4994
Practice Address - Fax:410-799-1044
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24625225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist