Provider Demographics
NPI:1669677530
Name:THERESA A. BELL, MD LLC
Entity Type:Organization
Organization Name:THERESA A. BELL, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-652-4040
Mailing Address - Street 1:310 CHRIS GAUPP DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4461
Mailing Address - Country:US
Mailing Address - Phone:609-652-4040
Mailing Address - Fax:609-652-5340
Practice Address - Street 1:310 CHRIS GAUPP DR.
Practice Address - Street 2:STE 105
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4461
Practice Address - Country:US
Practice Address - Phone:609-652-4040
Practice Address - Fax:609-652-5340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA061459002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ037849Medicare ID - Type Unspecified
NJ112229Medicare PIN
NJH15666Medicare UPIN