Provider Demographics
NPI:1376556530
Name:NICHOLAOS C BELLOS MD PA
Entity Type:Organization
Organization Name:NICHOLAOS C BELLOS MD PA
Other - Org Name:AB THERAPEUTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAOS
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-828-4702
Mailing Address - Street 1:2909 LEMMON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2909 LEMMON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2311
Practice Address - Country:US
Practice Address - Phone:214-887-6682
Practice Address - Fax:214-887-6686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193883336C0003X
3336H0001X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Not Answered3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4542040OtherOTHER ID NUMBER-COMMERCIAL NUMBER
4542040OtherOTHER ID NUMBER-COMMERCIAL NUMBER