Provider Demographics
NPI:1205918802
Name:SHESTOPALOVA, BELA (MD)
Entity type:Individual
Prefix:DR
First Name:BELA
Middle Name:
Last Name:SHESTOPALOVA
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 1:12405 GLEN MILL RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1908
Mailing Address - Country:US
Mailing Address - Phone:301-717-3355
Mailing Address - Fax:202-318-0745
Practice Address - Street 1:1105 SPRING ST STE G
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4026
Practice Address - Country:US
Practice Address - Phone:301-588-1181
Practice Address - Fax:301-588-0483
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051477207R00000X
VA0101055158207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD027001600Medicaid
MD027001600Medicaid
MDG80750Medicare UPIN