Provider Demographics
NPI:1003919978
Name:BELLINGER, EDWARD L (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:L
Last Name:BELLINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MEADE ST
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1813
Mailing Address - Country:US
Mailing Address - Phone:570-724-3636
Mailing Address - Fax:570-724-3326
Practice Address - Street 1:15 MEADE ST
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1813
Practice Address - Country:US
Practice Address - Phone:570-724-3636
Practice Address - Fax:570-724-3326
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021180E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA801909OtherFIRST PRIORITY
PAP00798599OtherRAILROAD MEDICARE
PA0008576330001Medicaid
PA070829OtherBLUE SHIELD
PAP00798599OtherRAILROAD MEDICARE
PA0008576330001Medicaid