Individual
MICHAEL GEORGE MELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1860 TOWN CENTER DR, SUITE 225, RESTON, VA 20190-5896
(703) 483-3610
(703) 483-3610
Mailing address
PO BOX 17334, BALTIMORE, MD 21297-1334
(703) 443-6717
(703) 443-8643
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
0101042579
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00350018
RR MEDICARE
VA
Enumeration date
02/14/2006
Last updated
01/09/2010
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