Provider Demographics
NPI:1891737565
Name:BELLIS, EDWIN HARRY III (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:HARRY
Last Name:BELLIS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:32071 BEAVER RUN DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1773
Mailing Address - Country:US
Mailing Address - Phone:410-546-6322
Mailing Address - Fax:410-546-6324
Practice Address - Street 1:32071 BEAVER RUN DR
Practice Address - Street 2:SUITE B
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1773
Practice Address - Country:US
Practice Address - Phone:410-546-6322
Practice Address - Fax:410-546-6324
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD28587208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC48833Medicare UPIN
563M872FMedicare ID - Type Unspecified