Provider Demographics
NPI:1255380044
Name:MELLISH, TODD D (DO)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:D
Last Name:MELLISH
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:6 TSIENNETO RD
Mailing Address - Street 2:STE 300
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1584
Mailing Address - Country:US
Mailing Address - Phone:603-216-0400
Mailing Address - Fax:603-216-3800
Practice Address - Street 1:4 ELLIOT WAY
Practice Address - Street 2:STE 102
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3551
Practice Address - Country:US
Practice Address - Phone:603-626-5900
Practice Address - Fax:603-625-2180
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2019-02-16
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Provider Licenses
StateLicense IDTaxonomies
NH11330207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
01YP03381NH03OtherANTHEM NH
H48938Medicare UPIN
MERE6401Medicare ID - Type Unspecified