Provider Demographics
NPI:1902946494
Name:DELBELLO, LLC
Entity Type:Organization
Organization Name:DELBELLO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:DELBELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-482-1681
Mailing Address - Street 1:PO BOX 715375
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-5375
Mailing Address - Country:US
Mailing Address - Phone:260-969-1950
Mailing Address - Fax:260-918-2137
Practice Address - Street 1:3124 E STATE BLVD
Practice Address - Street 2:SUITE 3F
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4763
Practice Address - Country:US
Practice Address - Phone:260-482-1681
Practice Address - Fax:260-482-1857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037213207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN110175714OtherRAILROAD MEDICARE
4134142OtherAETNA
1220OtherPHYSICIANS HEALTH PLAN
IN000000527354OtherANTHEM
0462448OtherCIGNA
IN100323980Medicaid
IN000000527354OtherANTHEM
IN110175714OtherRAILROAD MEDICARE
INE75755Medicare UPIN
0462448OtherCIGNA
IN100323980Medicaid
IN070880UMedicare PIN