Provider Demographics
NPI:1578554713
Name:BELCHER, DAVID MARK (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MARK
Last Name:BELCHER
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 1:191 INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7751
Mailing Address - Country:US
Mailing Address - Phone:617-773-5070
Mailing Address - Fax:617-472-2380
Practice Address - Street 1:191 INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7751
Practice Address - Country:US
Practice Address - Phone:617-773-5070
Practice Address - Fax:617-472-2380
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79152208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3122034Medicaid
MA079152OtherTUFTS HEALTH PLAN
MA200759OtherHPHC
MAJ14528OtherBLUE SHIELD OF MA
F78492Medicare UPIN