Provider Demographics
NPI:1952424228
Name:ANITA D'MELLO, MD, PC
Entity Type:Organization
Organization Name:ANITA D'MELLO, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DMELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:9184-205-7779
Mailing Address - Street 1:4 E CLARK BASS BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4269
Mailing Address - Country:US
Mailing Address - Phone:918-420-5779
Mailing Address - Fax:918-420-5882
Practice Address - Street 1:4 E CLARK BASS BLVD
Practice Address - Street 2:STE 204
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4269
Practice Address - Country:US
Practice Address - Phone:918-420-5779
Practice Address - Fax:918-420-5882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23770207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG16206Medicare UPIN