Provider Demographics
NPI:1689679938
Name:BELKOFF, LAURENCE H (DO)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:H
Last Name:BELKOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 PRESIDENTIAL BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1017
Mailing Address - Country:US
Mailing Address - Phone:610-667-3020
Mailing Address - Fax:610-667-1817
Practice Address - Street 1:1 PRESIDENTIAL BLVD
Practice Address - Street 2:STE 100
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1017
Practice Address - Country:US
Practice Address - Phone:610-667-3020
Practice Address - Fax:610-667-1817
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS005275L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010837230007Medicaid
PAE52502Medicare UPIN
PA452625Medicare ID - Type Unspecified