Provider Demographics
NPI:1407016405
Name:BELL, ATIBA E (MD)
Entity Type:Individual
Prefix:DR
First Name:ATIBA
Middle Name:E
Last Name:BELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E CAMDEN AVE APT N5
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-1614
Mailing Address - Country:US
Mailing Address - Phone:202-276-5006
Mailing Address - Fax:
Practice Address - Street 1:245 N 15TH ST
Practice Address - Street 2:MAIL STOP 1011
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1101
Practice Address - Country:US
Practice Address - Phone:215-762-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT188801207P00000X
TXN2400207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1407016405OtherTRICARE SOUTH
TX8CA046OtherBCBSTX
TX1407016405OtherBCBSTX
TX202760901Medicaid
TX1407016405OtherBCBSTX
TX202760901Medicaid
TX1407016405Medicare PIN