Provider Demographics
NPI:1760173082
Name:LONDON, BELLA (MD)
Entity Type:Individual
Prefix:MRS
First Name:BELLA
Middle Name:
Last Name:LONDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:BELLA
Other - Middle Name:
Other - Last Name:GUSTUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:MLC-7012
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:MLC-7012
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229
Practice Address - Country:US
Practice Address - Phone:513-636-4744
Practice Address - Fax:513-803-1174
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.253956390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program