Provider Demographics
NPI:1629176565
Name:BELTON, EDWARD D (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:D
Last Name:BELTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:E
Other - Middle Name:DEVAUGHN
Other - Last Name:BELTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1629 COLUMBIA ROAD NW
Mailing Address - Street 2:SUITE 334
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009
Mailing Address - Country:US
Mailing Address - Phone:202-332-1058
Mailing Address - Fax:202-332-1059
Practice Address - Street 1:1629 COLUMBIA ROAD NW
Practice Address - Street 2:SUITE 334
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009
Practice Address - Country:US
Practice Address - Phone:202-332-1058
Practice Address - Fax:202-332-1059
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD25586207RC0000X
MDD0004814207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC49680001OtherBCBS
178194Medicare ID - Type Unspecified
DC49680001OtherBCBS