Provider Demographics
NPI:1598864423
Name:BELLER, NANCY O (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:O
Last Name:BELLER
Suffix:
Gender:F
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 74567
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194
Mailing Address - Country:US
Mailing Address - Phone:440-974-4404
Mailing Address - Fax:440-974-4164
Practice Address - Street 1:9000 MENTOR AVE #105
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060
Practice Address - Country:US
Practice Address - Phone:440-974-4404
Practice Address - Fax:440-974-4164
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056733207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E58331Medicare UPIN