Basic Information
| Provider Information | |||||||||
| NPI: | 1134389414 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WENDY VAN BELLINGHAM, MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 200 | ||||||||
| Address2: | |||||||||
| City: | CLIFTON PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120650200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182297274 | ||||||||
| FaxNumber: | 5183481279 | ||||||||
| Practice Location | |||||||||
| Address1: | 1659 CENTRAL AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122054039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182297274 | ||||||||
| FaxNumber: | 5183481279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2008 | ||||||||
| LastUpdateDate: | 06/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | VAN BELLINGHAM | ||||||||
| AuthorizedOfficialFirstName: | WENDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5182297274 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 167992 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00984405 | 05 | NY | MEDICAID |