Individual
ANITA D'MELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4945 WILLIAMS DR, GEORGETOWN, TX 78633-2008
(512) 819-0500
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-8800
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
23770
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200027010A
—
OK
Enumeration date
07/15/2006
Last updated
01/11/2021
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