Individual provider Active NPI

Mellisa Mauldin, PA-C

  • Physician Assistant
  • Parkville, MD
National Provider Identifier
1104708221
Registry record updated Jul 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
21 Strabane CT
Parkville, MD 21234-1608
Phone
(732) 674-5729
NPI assigned
Jul 21, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

21 Strabane CT
Parkville, MD 21234-1608

Mailing address

21 Strabane CT
Parkville, MD 21234-1608

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251218004636 MD Practitioner - Physician Assistant 5496240202 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Greater Baltimore Medical CenterGroup PAC ID 1759276975, 350 clinicians

Practice addresses (Care Compare)

3701 N Charles St
South Chapman Building Suite 102
Towson, MD 21204-6808

6535 N Charles St
Baltimore, MD 21204-5822

6565 N Charles St
Baltimore, MD 21204-6808

6569 N Charles St
Suite 505
Baltimore, MD 21204-6808
Phone (443) 849-2658

6569 N Charles St PPW Room
307 GYN Specialists
Baltimore, MD 21204-6808
Phone (443) 849-6123

6569 N Charles Street
504 Hoover Low Vision GBMC
Baltimore, MD 21204-6808
Phone (443) 849-2658

6701 N Charles St
Baltamore, MD 21204-6808

6701 N Charles St BLDG
S Chapman BLDG Suite 102
Baltimore, MD 21204-6808

6701 N Charles St Unit
Baltimore, MD 21204-6808
Phone (443) 849-3131

Hospital & facility affiliations

  • Greater Baltimore Medical Center Hospital, Baltimore, MD, CCN 210044

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Greater Baltimore Medical Center, Inc. Physician Assistant CurrentSince Nov 10, 2025 Accepting new patients
Greater Baltimore Medical Center, Inc. CurrentSince Nov 10, 2025 Accepting new patients

Locations

6535 N Charles St
Ste 125
Towson, MD 21204
Phone (443) 849-3779

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1753056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753056000000",
    "number": "1104708221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 STRABANE CT",
            "city": "PARKVILLE",
            "state": "MD",
            "postal_code": "212341608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 STRABANE CT",
            "city": "PARKVILLE",
            "state": "MD",
            "postal_code": "212341608",
            "telephone_number": "732-674-5729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAULDIN",
        "first_name": "MELLISA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-21",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Parkville, MD

Sources for this page

Verify at the official NPI Registry.