Provider Demographics
NPI:1629002621
Name:MELLMAN, DAVID MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:MELLMAN
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:PO BOX 71183
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28272-1183
Mailing Address - Country:US
Mailing Address - Phone:540-616-1600
Mailing Address - Fax:540-686-1601
Practice Address - Street 1:160 EXETER DR STE 103
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22603-8614
Practice Address - Country:US
Practice Address - Phone:540-686-1600
Practice Address - Fax:540-686-1601
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012470312085R0202X
MDD00657622085R0202X, 2085R0204X
FLME1018792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL297KMedicare PIN
FLAL297JMedicare PIN
MD13257800Medicaid
980MR748Medicare PIN
I62851OtherUPIN
003139D70Medicare PIN