Provider Demographics
NPI:1164915633
Name:BELOGORODSKY, DIMITRY (DO)
Entity Type:Individual
Prefix:
First Name:DIMITRY
Middle Name:
Last Name:BELOGORODSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4577 BOONE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-4705
Mailing Address - Country:US
Mailing Address - Phone:215-531-0658
Mailing Address - Fax:
Practice Address - Street 1:2226 BLAKESLEE BOULEVARD DR E
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-9619
Practice Address - Country:US
Practice Address - Phone:610-297-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-10
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT018631207Q00000X, 207QS0010X
PAOS020327207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine