Provider Demographics
NPI:1316119704
Name:MELL, LOREN K (MD)
Entity type:Individual
Prefix:DR
First Name:LOREN
Middle Name:K
Last Name:MELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3855 HEALTH SCIENCES DR. MC0843
Mailing Address - Street 2:UCSD DEPARTMENT OF RADIATION ONCOLOGY
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093
Mailing Address - Country:US
Mailing Address - Phone:858-822-6040
Mailing Address - Fax:
Practice Address - Street 1:3855 HEALTH SCIENCES DR. MC0843
Practice Address - Street 2:UCSD DEPARTMENT OF RADIATION ONCOLOGY
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093
Practice Address - Country:US
Practice Address - Phone:858-822-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1047042085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABG321Medicare PIN
CAAM900YMedicare PIN