Provider Demographics
NPI:1629357736
Name:GARY C BELLMAN M D A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GARY C BELLMAN M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-703-9500
Mailing Address - Street 1:22647 VENTURA BLVD
Mailing Address - Street 2:SUTIE 177
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1416
Mailing Address - Country:US
Mailing Address - Phone:818-912-1899
Mailing Address - Fax:818-703-0995
Practice Address - Street 1:23101 SHERMAN PL
Practice Address - Street 2:SUITE 402
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-2003
Practice Address - Country:US
Practice Address - Phone:818-912-1899
Practice Address - Fax:818-703-0995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-06
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFJ252AMedicare PIN