Provider Demographics
NPI:1538329784
Name:PARKER-MELLO, KELLY G (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:G
Last Name:PARKER-MELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SANFORD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-5533
Mailing Address - Country:US
Mailing Address - Phone:207-641-6555
Mailing Address - Fax:
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3134
Practice Address - Country:US
Practice Address - Phone:207-662-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME018956208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics