Provider Demographics
NPI:1902943301
Name:BELLOVIN, SABRA M (MD)
Entity Type:Individual
Prefix:
First Name:SABRA
Middle Name:M
Last Name:BELLOVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 866
Mailing Address - Street 2:
Mailing Address - City:MATHEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23109-0866
Mailing Address - Country:US
Mailing Address - Phone:804-725-9191
Mailing Address - Fax:804-725-9191
Practice Address - Street 1:10980 BUCKLEY HALL ROAD
Practice Address - Street 2:BUILDING 5
Practice Address - City:MATHEWS
Practice Address - State:VA
Practice Address - Zip Code:23109
Practice Address - Country:US
Practice Address - Phone:804-725-9191
Practice Address - Fax:804-725-9120
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA266789OtherANTHEM
012772B28Medicare PIN
VA266789OtherANTHEM
VAG63432Medicare UPIN