Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 272986 | MA |
NPI | 1235498064 |
---|---|
Provider Name | Dr. Brandis Belt |
First Address | South Orange, NJ 07079-1811 |
Second Address | Gardner, MA 01440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2012 |
Last Update Date | 30/05/2018 |