Individual
DR. THEOFANIE MELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 FRUIT ST, ELECTROPHYSIOLOGY LAB ARRHYTHMIA SERVICE GRB 109, BOSTON, MA 02114-2621
(617) 726-4662
(617) 726-3852
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 726-4662
(617) 726-3852
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
80414
MA
207RC0000X
Cardiovascular Disease Physician
Primary
80414
MA
207RC0001X
Clinical Cardiac Electrophysiology Physician
80414
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3193659
—
MA
01
—
779923
TUFTS HEALTH PLAN
MA
01
—
J21120
BCBS MA
MA
Enumeration date
11/10/2005
Last updated
11/26/2012
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