Provider Demographics
NPI:1528599859
Name:BELLEVUE, LOURDEMILLARD (MD)
Entity type:Individual
Prefix:
First Name:LOURDEMILLARD
Middle Name:
Last Name:BELLEVUE
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 1:115 MAIN ST STE 301
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-2949
Mailing Address - Country:US
Mailing Address - Phone:914-771-7070
Mailing Address - Fax:
Practice Address - Street 1:115 MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-2949
Practice Address - Country:US
Practice Address - Phone:914-771-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307787208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty