Individual
ERIC MELLENCAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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