Provider Demographics
NPI:1285648667
Name:PETTUS-BELLAMY, BRENDA KAREN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:KAREN
Last Name:PETTUS-BELLAMY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3300 DUNWOOD RIDGE TERRACE
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721
Mailing Address - Country:US
Mailing Address - Phone:301-218-1614
Mailing Address - Fax:301-218-1613
Practice Address - Street 1:6915 LAUREL BOWIE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715
Practice Address - Country:US
Practice Address - Phone:301-249-8838
Practice Address - Fax:301-249-5334
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD33204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H25404Medicare UPIN