Provider Demographics
NPI:1538266093
Name:MELLEN, PAUL F (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:F
Last Name:MELLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30309
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29417-0309
Mailing Address - Country:US
Mailing Address - Phone:843-554-9300
Mailing Address - Fax:843-566-8780
Practice Address - Street 1:2401 W. UNIVERSITY AVENUE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303
Practice Address - Country:US
Practice Address - Phone:765-747-3201
Practice Address - Fax:765-741-2905
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056925A207ZF0201X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000258476OtherBLUE CROSS & BLUE SHIELD
IN200414980Medicaid
IN000000024629OtherM-PLAN
OH2099554Medicaid
020434700OtherBLACK LUNG
IN6470OtherPHYSICIAN HEALTH PLAN
IN000000024629OtherM-PLAN
IN200414980Medicaid
INP00018457Medicare PIN