Provider Demographics
NPI:1275591182
Name:BELOCK, CARL JAMES (DPM)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:JAMES
Last Name:BELOCK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 KAYHOE RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3532
Mailing Address - Country:US
Mailing Address - Phone:804-217-6574
Mailing Address - Fax:
Practice Address - Street 1:7575 COLD HARBOR RD
Practice Address - Street 2:SUITE 2-A
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-1600
Practice Address - Country:US
Practice Address - Phone:804-730-1300
Practice Address - Fax:804-730-8843
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300949213E00000X
IN07001004A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA183835OtherANTHEM/BC/BS MECHANICSVIL
VAP00242003OtherRAILROAD-MEDICARE
VA010199972Medicaid
VA010199760Medicaid
VA183837OtherANTHEM/BC/BS ASHLAND
VA008405C15Medicare ID - Type UnspecifiedMECHANICSVILLE
VAP00242003OtherRAILROAD-MEDICARE
VA010199972Medicaid