Basic Information
| Provider Information | |||||||||
| NPI: | 1962791442 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GREGORIO M. BELLOSO M.D. P.A. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 5302 CHINABERRY DR | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218011265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103416321 | ||||||||
| FaxNumber: | 4103417082 | ||||||||
| Practice Location | |||||||||
| Address1: | 11974 EDGEHILL TERRACE RD | ||||||||
| Address2: | |||||||||
| City: | PRINCESS ANNE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218532105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106510011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2011 | ||||||||
| LastUpdateDate: | 04/05/2011 | ||||||||
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| AuthorizedOfficialLastName: | BELLOSO | ||||||||
| AuthorizedOfficialFirstName: | GREGORIO | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 14103416321 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D29505 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 46234 | 05 | MD | MEDICAID |