Provider Demographics
NPI:1811002736
Name:DE MELO, ANTONIO M (DPM)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:M
Last Name:DE MELO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:222 MILLIKEN BLVD
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-1623
Mailing Address - Country:US
Mailing Address - Phone:508-679-5700
Mailing Address - Fax:508-679-7759
Practice Address - Street 1:222 MILLIKEN BLVD
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-1623
Practice Address - Country:US
Practice Address - Phone:508-679-5700
Practice Address - Fax:508-679-7759
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2062213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADEY75093Medicare UPIN
MAU64800Medicare UPIN