Healthcare Provider Details

I. General information

NPI: 1811002736
Provider Name (Legal Business Name): ANTONIO M. DE MELO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 MILLIKEN BLVD
FALL RIVER MA
02721-1623
US

IV. Provider business mailing address

222 MILLIKEN BLVD
FALL RIVER MA
02721-1623
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-5700
  • Fax: 508-679-7759
Mailing address:
  • Phone: 508-679-5700
  • Fax: 508-679-7759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2062
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: