Basic Information
| Provider Information | |||||||||
| NPI: | 1205812716 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELARDO | ||||||||
| FirstName: | LITO | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6724 WALES AVE NW | ||||||||
| Address2: | |||||||||
| City: | MASSILLON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446469006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308374264 | ||||||||
| FaxNumber: | 3308379195 | ||||||||
| Practice Location | |||||||||
| Address1: | 5147 MANCHESTER RD | ||||||||
| Address2: | |||||||||
| City: | NEW FRANKLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443193911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306443747 | ||||||||
| FaxNumber: | 3306449815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2005 | ||||||||
| LastUpdateDate: | 01/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35068185 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0250473 | 05 | OH | MEDICAID | 080104233 | 01 | OH | RAILROAD MEDICARE NUMBER | OTHER |