Provider Demographics
NPI:1558436683
Name:BELFAST PEDIATRICS, LLC
Entity Type:Organization
Organization Name:BELFAST PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR AND PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:H
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-338-4257
Mailing Address - Street 1:16 FAHEY ST STE 107
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6029
Mailing Address - Country:US
Mailing Address - Phone:207-338-4257
Mailing Address - Fax:207-338-4258
Practice Address - Street 1:16 FAHEY ST STE 107
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6029
Practice Address - Country:US
Practice Address - Phone:207-338-4257
Practice Address - Fax:207-338-4258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty