Provider Demographics
NPI:1205027919
Name:BELITSOS, PETER JOHN
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JOHN
Last Name:BELITSOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 OSLER DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7621
Mailing Address - Country:US
Mailing Address - Phone:410-828-1800
Mailing Address - Fax:410-828-7863
Practice Address - Street 1:7401 OSLER DR STE 102
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-7621
Practice Address - Country:US
Practice Address - Phone:410-828-1800
Practice Address - Fax:410-828-7863
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor