Provider Demographics
NPI:1033705835
Name:BELMONT FAMILY PRACTICE, INC.
Entity Type:Organization
Organization Name:BELMONT FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-978-7317
Mailing Address - Street 1:1346 BELMONT AVE STE 602
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-4589
Mailing Address - Country:US
Mailing Address - Phone:443-978-7317
Mailing Address - Fax:443-736-4080
Practice Address - Street 1:1346 BELMONT AVE STE 602
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4589
Practice Address - Country:US
Practice Address - Phone:443-978-7317
Practice Address - Fax:443-736-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty