Basic Information
| Provider Information | |||||||||
| NPI: | 1881699585 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELVEDERE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 715 E WESTERN RESERVE RD | ||||||||
| Address2: | |||||||||
| City: | POLAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445143358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307263204 | ||||||||
| FaxNumber: | 3307299316 | ||||||||
| Practice Location | |||||||||
| Address1: | 715 E WESTERN RESERVE RD | ||||||||
| Address2: | |||||||||
| City: | POLAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445143358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307263204 | ||||||||
| FaxNumber: | 3307299316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2005 | ||||||||
| LastUpdateDate: | 09/19/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35061281 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207UN0901X | 35061281 | OH | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 18816995850 | 01 | PA | NPI# | OTHER | 0836886 | 05 | OH | MEDICAID | 18816995850 | 01 | OH | NPI # | OTHER |