Provider Demographics
NPI:1225068737
Name:BELLO, ERIC G (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:G
Last Name:BELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PATROON CREEK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-5014
Mailing Address - Country:US
Mailing Address - Phone:518-445-4444
Mailing Address - Fax:518-618-1665
Practice Address - Street 1:400 PATROON CREEK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-5014
Practice Address - Country:US
Practice Address - Phone:518-445-4444
Practice Address - Fax:518-618-1665
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138828-1207P00000X
NY138828207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY361858OtherMVP
NY10027104OtherCDPHP
NY01831052Medicaid
NYRB5753Medicare PIN
NY361858OtherMVP