Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 24625 | MD |
NPI | 1003241316 |
---|---|
Provider Name | Darien Antoine Mellerson |
First Address | Glen Burnie, MD 21061-5884 |
Second Address | Glen Burnie, MD 21061-5884 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2013 |
Last Update Date | 04/02/2019 |