Provider Demographics
NPI:1487908141
Name:MELLA, JOSE MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MANUEL
Last Name:MELLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:400 BROOKLINE AVE APT 22B
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5409
Mailing Address - Country:US
Mailing Address - Phone:857-210-7652
Mailing Address - Fax:
Practice Address - Street 1:330 BROOKLINE AVE DA 501
Practice Address - Street 2:EAST CAMPUS, BETH ISRAEL DEACONESS MEDICAL CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5403
Practice Address - Country:US
Practice Address - Phone:617-667-8424
Practice Address - Fax:617-667-8144
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA251146207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology