Provider Demographics
NPI:1912192568
Name:BELLUSO, ROBERT L (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:BELLUSO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1070 OLD NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15333-2114
Mailing Address - Country:US
Mailing Address - Phone:724-632-6801
Mailing Address - Fax:724-632-6312
Practice Address - Street 1:200 CHAMBER PLZ
Practice Address - Street 2:
Practice Address - City:CHARLEROI
Practice Address - State:PA
Practice Address - Zip Code:15022-1605
Practice Address - Country:US
Practice Address - Phone:724-483-5482
Practice Address - Fax:724-483-5856
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007288440105Medicaid
PA1007288440027Medicaid
PABE2068817OtherHIGHMARK
PA102202071Medicaid
PA102202071Medicaid