Basic Information
| Provider Information | |||||||||
| NPI: | 1598756991 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELLORS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 143 LONGWATER DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
| FaxNumber: | 7818712940 | ||||||||
| Practice Location | |||||||||
| Address1: | 143 LONGWATER DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
| FaxNumber: | 7818786750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 12/21/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 39582 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0195332 | 05 | MA | MEDICAID | 042297845 | 01 | MA | HCVM | OTHER | 700417 | 01 | MA | TUFTS | OTHER | C04862 | 01 | MA | BCBS | OTHER | 0019261 | 01 | MA | NEIGHBORHOOD HLTH PLAN | OTHER | 042297845 | 01 | MA | TRICARE | OTHER | 7613316 | 01 | MA | AETNA | OTHER | 042297845 | 01 | MA | UNITED HEALTH CARE | OTHER | 042297845 | 01 | MA | GIC UNICARE | OTHER | 042297845 | 01 | MA | PRIVATE HEALTHCARE SYSTEM | OTHER | B10182106 | 01 | MA | CIGNA | OTHER | 45684 | 01 | MA | FALLON | OTHER | 61736 | 01 | MA | HVD PILGRIM HEALTH CARE | OTHER | B10182101 | 01 | MA | CIGNA INT | OTHER |