Provider Demographics
NPI:1376637413
Name:BELLO, MARY R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:R
Last Name:BELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:400 FRANKLIN TPKE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-3516
Mailing Address - Country:US
Mailing Address - Phone:201-327-3333
Mailing Address - Fax:210-327-2575
Practice Address - Street 1:400 FRANKLIN TPKE
Practice Address - Street 2:SUITE 106
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-3516
Practice Address - Country:US
Practice Address - Phone:201-327-3333
Practice Address - Fax:210-327-2575
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA49418174400000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1043763OtherAETNA U.S. HEALTHCARE
NJ1920804Medicaid
NJ2K2032OtherHEALTHNET
NJ2K2032OtherHEALTHNET
NJ1920804Medicaid