1538373907 NPI number — NARESH BELLAM MD

Table of content: NARESH BELLAM MD (NPI 1538373907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538373907 NPI number — NARESH BELLAM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELLAM
Provider First Name:
NARESH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1538373907
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4145 CARMICHAEL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36106-2803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-273-7000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
645 MCQUEEN SMITH ROAD
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
PRATTVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36066-7263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-351-1000
Provider Business Practice Location Address Fax Number:
334-273-2228
Provider Enumeration Date:
05/09/2007

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: 207RH0003X , with the licence number:  27885 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 051598366 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 110250 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051598364 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051598365 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 110253 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00829045 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 110249 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51598191 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 110251 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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