Provider Demographics
NPI:1689668535
Name:BELLO, BRODERICK CANDE (MD)
Entity Type:Individual
Prefix:
First Name:BRODERICK
Middle Name:CANDE
Last Name:BELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7200
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0200
Mailing Address - Country:US
Mailing Address - Phone:252-937-0200
Mailing Address - Fax:252-451-0056
Practice Address - Street 1:102 S EASTPOINTE AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-1849
Practice Address - Country:US
Practice Address - Phone:252-459-4012
Practice Address - Fax:252-937-3101
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4925344OtherCIGNA HEALTHCARE
NC89128VFMedicaid
NC128VFOtherBCBSNC
NC2067731OtherUNITED HEALTH CARE
NC80170029OtherRAILROAD MEDICARE
NCA5443OtherMEDCOST
NCH23546Medicare UPIN