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Contact Information

ALEXANDER C MELLIN, MS, ATC, LAT
COSTELLO ATHLETIC CENTER
275 RIVERSIDE STREET
LOWELL, MA01854
 Phone: 978-934-2373
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Athletic Trainer

2255A2300X
Indicates primary specialty

NPI Profile & details for ALEXANDER C MELLIN · (Male)

NPI # 1780224246
Status Active
Credentials MS, ATC, LAT
Entity Individual
Enumeration date 01/13/2020
Last updated 01/13/2020 - About 6 years ago
Sole proprietor 1 Yes
Identifiers
  • License # 2000023944
  • Other 2000023944 NATA BOARD OF CERTIFICATION, CERTIFIED ATHLETIC TRAINER
  • MA Other 3249-AH-AT COMMONWEALTH OF MASSACHUSETTS DIVISION OF PROFESSIONAL LICENSURE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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