Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OT018631 | PA |
Y | 207QS0010X | Family Doctor - Sports Medicine | OT018631 | PA |
NPI | 1164915633 |
---|---|
Provider Name | Dimitry Belogorodsky |
First Address | Philadelphia, PA 19128-4705 |
Second Address | Allentown, PA 18104-5052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2018 |
Last Update Date | 14/06/2021 |