Individual
JEREME EDWIN MELLENTHIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
US DEPT OF STATE, M/MED/QI, SA-1, WASHINGTON, DC 20522-0001
(202) 663-2453
(202) 663-3247
Mailing address
US DEPT OF STATE, M/MED/QI, SA-1, WASHINGTON, DC 20522-0001
(202) 663-2453
(202) 663-3247
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
103637
NC
Other
Enumeration date
02/14/2008
Last updated
02/14/2008
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