Provider Demographics
NPI:1831659689
Name:MELL, ANTHONY J (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:MELL
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Gender:M
Credentials:MD, MBA
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Mailing Address - Street 1:BMC PROVIDER ENROLLMENT OFFICE
Mailing Address - Street 2:960 MASSACHUSETTS AVE,.2ND FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-414-5405
Mailing Address - Fax:617-414-6031
Practice Address - Street 1:801 MASSACHUSETTS AVE.
Practice Address - Street 2:CROSSTOWN BLDG FL 7
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-414-4841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2024-04-03
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Provider Licenses
StateLicense IDTaxonomies
MA290936208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics