Provider Demographics
NPI:1033129457
Name:BELLEDONNE, MARIO O (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:O
Last Name:BELLEDONNE
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 1:8200 TUCKERMAN LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3744
Mailing Address - Country:US
Mailing Address - Phone:301-605-7878
Mailing Address - Fax:301-605-7878
Practice Address - Street 1:8200 TUCKERMAN LN
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3744
Practice Address - Country:US
Practice Address - Phone:301-605-7878
Practice Address - Fax:301-605-7878
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD23177207R00000X, 207RC0200X, 207RN0300X
MDD0023177207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3233311100Medicaid
MD83742OtherUNITED HEALTH
MD879065OtherALLIANCE PPO
MD379065OtherMAMSI, PPO
MD6009-001OtherCARE FIRST BLUE CHOICE
MD379065OtherMAMSI, PPO
MD3233311100Medicaid