Provider Demographics
NPI:1477855823
Name:MARIO O BELLEDONNE PA
Entity Type:Organization
Organization Name:MARIO O BELLEDONNE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:O
Authorized Official - Last Name:BELLEDONNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-605-7878
Mailing Address - Street 1:8200 TUCKERMAN LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3744
Mailing Address - Country:US
Mailing Address - Phone:301-605-7878
Mailing Address - Fax:301-605-7878
Practice Address - Street 1:8200 TUCKERMAN LN
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3744
Practice Address - Country:US
Practice Address - Phone:301-605-7878
Practice Address - Fax:301-605-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD-23177207R00000X, 207RC0200X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6009-0001OtherCAREFIRST BC/BS
MD4050855OtherAETNA
MD272698OtherTRICARE
MD323311100Medicaid
MD1020192OtherCIGNA
MD127742OtherJHMSC TRICARE
MD379065OtherMAMSI
MD837442OtherUHC
MD4050855OtherAETNA
MD41146Medicare PIN