Individual
ERIC MELLENCAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 981-7037
Mailing address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 981-7037
(540) 342-1757
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101243089
VA
2085R0202X
Diagnostic Radiology Physician
C10006375
DE
2085R0202X
Diagnostic Radiology Physician
MD040130E
PA
2085R0204X
Vascular & Interventional Radiology Physician
C1-0006375
DE
2085R0204X
Vascular & Interventional Radiology Physician
MD040130E
PA
Other
Enumeration date
07/29/2005
Last updated
02/08/2019
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