Provider Demographics
NPI:1730108358
Name:MELLEN, PHILIP BATSON (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:BATSON
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 1:1800 BEACH DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-1553
Mailing Address - Country:US
Mailing Address - Phone:228-897-4514
Mailing Address - Fax:
Practice Address - Street 1:1800 BEACH DR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-1553
Practice Address - Country:US
Practice Address - Phone:228-897-4514
Practice Address - Fax:228-897-4481
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19823207RH0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS7214746OtherAETNA
MS07384751Medicaid
MS7214746OtherAETNA
MS110003019Medicare PIN