Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 35041218 | OH |
NPI | 1003862335 |
---|---|
Provider Name | Marcello M. Mellino |
First Address | Fairview Park, OH 44126-3494 |
Second Address | Fairview Park, OH 44126-3494 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 12/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0429450 | (05) | OH |
C01854 | (02) | OH |