Provider Demographics
NPI:1639161169
Name:BELLANTONI, JON J (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:J
Last Name:BELLANTONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:520 UPPER CHESAPEAKE DR
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4339
Mailing Address - Country:US
Mailing Address - Phone:443-643-4300
Mailing Address - Fax:443-643-4351
Practice Address - Street 1:308 N UNION AVE
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-2825
Practice Address - Country:US
Practice Address - Phone:410-939-3121
Practice Address - Fax:410-939-8278
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033079174400000X
MDD33079207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD232921200Medicaid
B69959Medicare UPIN
MDKQ13LF38Medicare ID - Type Unspecified