Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | MD461360 | PA |
N | 208000000X | Pediatrician | 35770 | CO |
N | 208000000X | Pediatrician | MD461360 | PA |
NPI | 1730145772 |
---|---|
Provider Name | Gary Bellus |
First Address | Danville, PA 17822-4903 |
Second Address | Danville, PA 17822-7106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 12/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01357706 | (05) | CO |