Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD026570E | PA |
NPI | 1053329847 |
---|---|
Provider Name | Theodore Belis |
First Address | Altoona, PA 16602-2415 |
Second Address | Altoona, PA 16602-2415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B33955 | (02) | PA |