Provider Demographics
NPI:1295844074
Name:BELLOMO, ANTHONY FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:FRANCIS
Last Name:BELLOMO
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 1:2805 J ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4307
Mailing Address - Country:US
Mailing Address - Phone:916-441-1973
Mailing Address - Fax:916-441-1971
Practice Address - Street 1:2805 J STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4307
Practice Address - Country:US
Practice Address - Phone:916-441-1973
Practice Address - Fax:916-441-1971
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79283207XS0117X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G792830OtherBLUE SHIELD
CAP00000560OtherRAILROAD MEDICARE
CA00G792831Medicare ID - Type UnspecifiedMEDICARE
CAF92808Medicare UPIN