Provider Demographics
NPI:1629163332
Name:MARSHALL E. BELAGA, M.D. & BRENDA C. PRICE, M.D., P.L.L.C.
Entity Type:Organization
Organization Name:MARSHALL E. BELAGA, M.D. & BRENDA C. PRICE, M.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-664-0204
Mailing Address - Street 1:98 BURNHAM RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2759
Mailing Address - Country:US
Mailing Address - Phone:601-664-0204
Mailing Address - Fax:
Practice Address - Street 1:98 BURNHAM RD
Practice Address - Street 2:SUITE A
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2759
Practice Address - Country:US
Practice Address - Phone:601-664-0204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS158492084F0202X, 2084P0800X, 2084P0805X
MS489262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic PsychiatryGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03222261Medicaid
MSC03060Medicare PIN