Provider Demographics
NPI:1316002199
Name:BELLVILLE, DAVID E (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:BELLVILLE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 LEXINGTON AVE
Mailing Address - Street 2:PO BOX 1595
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2843
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:2025 CARTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7731
Practice Address - Country:US
Practice Address - Phone:606-408-4900
Practice Address - Fax:606-408-2749
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA227363A00000X
OH002898363A00000X
WV683363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95000659Medicaid
KY0351411Medicare ID - Type Unspecified
P02323Medicare UPIN
KY0307614Medicare ID - Type Unspecified
KY95000659Medicaid
KY0632907Medicare ID - Type Unspecified