Provider Demographics
NPI:1225011240
Name:BELARDI, ALBERT ADAM (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:ADAM
Last Name:BELARDI
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 1:3998 FAIR RIDGE DR.
Mailing Address - Street 2:SUITE # 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2921
Mailing Address - Country:US
Mailing Address - Phone:703-295-9360
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:746 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510
Practice Address - Country:US
Practice Address - Phone:570-346-7797
Practice Address - Fax:570-342-9802
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045789L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012909520008Medicaid
PAP00075995OtherRR MEDICARE
PA0012909520008Medicaid
PA068612Medicare PIN
PAP00075995OtherRR MEDICARE