Provider Demographics
NPI:1548450307
Name:DR. EDWIN BELLIS MD
Entity type:Organization
Organization Name:DR. EDWIN BELLIS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-341-6420
Mailing Address - Street 1:PO BOX 1859
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1859
Mailing Address - Country:US
Mailing Address - Phone:410-546-6322
Mailing Address - Fax:410-546-6324
Practice Address - Street 1:32071 BEAVER RUN DR
Practice Address - Street 2:STE B
Practice Address - City:SALIBURY
Practice Address - State:MD
Practice Address - Zip Code:21804
Practice Address - Country:US
Practice Address - Phone:410-546-6322
Practice Address - Fax:410-546-6324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0028587208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD563MMedicare PIN