Basic Information
Provider Information | |||||||||
NPI: | 1528166618 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BELLOT | ||||||||
FirstName: | CHARMAINE | ||||||||
MiddleName: | GERALDINE | ||||||||
NamePrefix: | MISS | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 9048 SUGAR EST | ||||||||
Address2: |   | ||||||||
City: | ST THOMAS | ||||||||
State: | VI | ||||||||
PostalCode: | 008023634 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3407768311 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 9048 SUGAR EST | ||||||||
Address2: | ROY L SCHNEIDER HOSPITAL | ||||||||
City: | ST THOMAS | ||||||||
State: | VI | ||||||||
PostalCode: | 008023634 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3407768311 | ||||||||
FaxNumber: | 3407146322 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/20/2006 | ||||||||
LastUpdateDate: | 04/08/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 005 | VI | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   |
ID Information
ID | Type | State | Issuer | Description | 239782300000013 | 01 | VI | PHYSICIAN ASSISTANT | OTHER |