Provider Demographics
NPI:1942499603
Name:BELLOSO, GREGORIO MELODIA (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORIO
Middle Name:MELODIA
Last Name:BELLOSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5302 CHINABERRY DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-1265
Mailing Address - Country:US
Mailing Address - Phone:410-341-6321
Mailing Address - Fax:410-341-7082
Practice Address - Street 1:5302 CHINABERRY DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-1265
Practice Address - Country:US
Practice Address - Phone:410-341-6321
Practice Address - Fax:410-341-7082
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD29505207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD46234Medicaid
DEOOOO653701Medicaid
DEOOOO653701Medicaid
DE447343Medicare PIN