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Individual
TIMOTHY J MELLO
Active
Individual
TIMOTHY J MELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0416P
NH
363A00000X
Physician Assistant
Primary
0550030562
VT
363AS0400X
Surgical Physician Assistant
0416P
NH
363AS0400X
Surgical Physician Assistant
0550030562
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
228223
CIGNA
—
05
—
30334363
—
NH
01
—
341729
MVP
—
01
—
58641
BLUECROSS
VT
05
—
VN1017
—
VT
Enumeration date
08/11/2006
Last updated
02/28/2008
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