1720375512 NPI number — MR. MARK ANTONIO BELARDO SR. RPH.

Table of content: MR. MARK ANTONIO BELARDO SR. RPH. (NPI 1720375512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720375512 NPI number — MR. MARK ANTONIO BELARDO SR. RPH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELARDO
Provider First Name:
MARK
Provider Middle Name:
ANTONIO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
RPH.
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:
1720375512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1245 N MILITARY HWY
Provider Second Line Business Mailing Address:
TARGET STORE 1048
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23502-2228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-461-9356
Provider Business Mailing Address Fax Number:
757-461-9356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1245 N MILITARY HWY
Provider Second Line Business Practice Location Address:
TARGET STORE 1048
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23502-2228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-461-9356
Provider Business Practice Location Address Fax Number:
757-461-9356
Provider Enumeration Date:
06/30/2011

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: 183500000X , with the licence number:  0202012576 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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