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General NPI Number Information
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NPI Number | 1518091008
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Entity Type | Organization
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Legal Business Name | NANCY R. MELLIN, MD
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 07/16/2007
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Provider Practice Location Address
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Address Line | 15770 PAUL VEGA MD DR SUITE #204
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City | HAMMOND
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State | LA
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Zip | 70403-1475
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Country | US
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Telephone | 985-542-9155
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Fax |
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Provider Business Mailing Address
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Address Line | 15770 PAUL VEGA MD DR SUITE #204
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City | HAMMOND
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State | LA
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Zip | 70403-1475
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Country | US
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Telephone | 985-542-9155
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NANCY R MELLIN
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Credential | MD
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Telephone | 985-542-9155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 020570
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License Number State | LA
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