Provider Demographics
NPI:1619080744
Name:BELENKO, MICHAEL I (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:I
Last Name:BELENKO
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 1:800 VINIAL ST
Mailing Address - Street 2:B407A
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-5151
Mailing Address - Country:US
Mailing Address - Phone:412-323-4402
Mailing Address - Fax:412-323-4418
Practice Address - Street 1:777 RURAL AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3109
Practice Address - Country:US
Practice Address - Phone:570-321-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039643E207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA478439OtherHIGHMARK/BLUE SHIELD
PA220033349OtherRR MEDICARE
PA0011040460007Medicaid
PA815185OtherFIRST PRIORITY/HMO NE PA
PA220033349Medicare PIN
PA0011040460007Medicaid
B42194Medicare UPIN
PA478439OtherHIGHMARK/BLUE SHIELD