Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | D23177 | MD |
N | 111NI0900X | Internist | D23177 | MD |
N | 207RC0200X | Critical Care Medicine | D23177 | MD |
N | 207RN0300X | Nephrologist | D0023177 | MD |
Y | 207RN0300X | Nephrologist | D23177 | MD |
NPI | 1033129457 |
---|---|
Provider Name | Dr. Mario O Belledonne |
First Address | Potomac, MD 20854-3744 |
Second Address | Potomac, MD 20854-3744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 29/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3233311100 | (05) | MD |
379065 | MAMSI, PPO (01) | MD |
6009-001 | CARE FIRST BLUE CHOICE (01) | MD |
83742 | UNITED HEALTH (01) | MD |
879065 | ALLIANCE PPO (01) | MD |
B994913 | (02) | MD |