Provider Demographics
NPI:1093978322
Name:BELFONTE, CASSIUS DIEGO (MD)
Entity Type:Individual
Prefix:
First Name:CASSIUS
Middle Name:DIEGO
Last Name:BELFONTE
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 1:985 PRINCE FREDERICK BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3492
Mailing Address - Country:US
Mailing Address - Phone:410-535-2005
Mailing Address - Fax:410-535-4850
Practice Address - Street 1:110 HOSPITAL RD
Practice Address - Street 2:SUITE 306
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4044
Practice Address - Country:US
Practice Address - Phone:410-414-6559
Practice Address - Fax:410-414-5332
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0076683207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease