Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 016021 | ME |
Y | 2080P0214X | Pediatric Pulmonologist | 016021 | ME |
NPI | 1003846361 |
---|---|
Provider Name | Dr. Thomas Mellow |
First Address | Scarborough, ME 04074-7609 |
Second Address | Portland, ME 04102-3100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 16/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30203388 | (05) | NH |
331790099 | (05) | ME |
F79279 | (02) | ME |