1033129457 NPI number — DR. MARIO O BELLEDONNE M.D.

Table of content: DR. MARIO O BELLEDONNE M.D. (NPI 1033129457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033129457 NPI number — DR. MARIO O BELLEDONNE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELLEDONNE
Provider First Name:
MARIO
Provider Middle Name:
O
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033129457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8200 TUCKERMAN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POTOMAC
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20854-3744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-605-7878
Provider Business Mailing Address Fax Number:
301-605-7878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8200 TUCKERMAN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POTOMAC
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20854-3744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-605-7878
Provider Business Practice Location Address Fax Number:
301-605-7878
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  D23177 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: D23177 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: D0023177 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: D23177 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3233311100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 83742 . This is a "UNITED HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 879065 . This is a "ALLIANCE PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 379065 . This is a "MAMSI, PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 6009-001 . This is a "CARE FIRST BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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