Basic Information
| Provider Information | |||||||||
| NPI: | 1053704924 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELLAMY | ||||||||
| FirstName: | SAMANTHA | ||||||||
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| Credential: | R.T (R) | ||||||||
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| Mailing Information | |||||||||
| Address1: | 667 SHAMEWELL RD | ||||||||
| Address2: | |||||||||
| City: | BENTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420255773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702055292 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17 BELMONT AVE | ||||||||
| Address2: | |||||||||
| City: | BRATTLEBORO | ||||||||
| State: | VT | ||||||||
| PostalCode: | 053017601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022570341 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2015 | ||||||||
| LastUpdateDate: | 03/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247100000X | 18327 | KY | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist |
No ID Information.