Provider Demographics
NPI:1154946747
Name:MELLITS, SAMUEL PHILIP (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:PHILIP
Last Name:MELLITS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:347 LLANDRILLO RD
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2336
Mailing Address - Country:US
Mailing Address - Phone:610-389-2535
Mailing Address - Fax:
Practice Address - Street 1:100 E LANCASTER AVE STE 301
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3446
Practice Address - Country:US
Practice Address - Phone:484-476-4650
Practice Address - Fax:484-476-2422
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT221221207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology