Provider Demographics
NPI:1518961275
Name:BELL, BRIAN WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:WAYNE
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:PO BOX 601884
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1884
Mailing Address - Country:US
Mailing Address - Phone:828-245-3158
Mailing Address - Fax:828-247-6484
Practice Address - Street 1:249 OAK ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-3585
Practice Address - Country:US
Practice Address - Phone:828-245-3158
Practice Address - Fax:828-247-6484
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18850207Q00000X
NC9701245207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1518961275Medicaid
SC188503Medicaid
NC891345UMedicaid
NCP00362116OtherMEDICARE RAILROAD PROVIDE
SCP01077510OtherRAILROAD MEDICARE
NC1345UOtherBCBS PROVIDER NUMBER
NC1518961275Medicaid
NCG77485Medicare UPIN
NC891345UMedicaid