Provider Demographics
NPI:1962471128
Name:BELLOS, NICHOLAOS C (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAOS
Middle Name:C
Last Name:BELLOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 OAK LAWN AVE
Mailing Address - Street 2:500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4021
Mailing Address - Country:US
Mailing Address - Phone:214-396-4201
Mailing Address - Fax:469-453-3335
Practice Address - Street 1:2603 OAK LAWN AVE
Practice Address - Street 2:500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4021
Practice Address - Country:US
Practice Address - Phone:214-396-4201
Practice Address - Fax:469-453-3335
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2108207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128539706Medicaid
4273577OtherAETNA
8A9630OtherBCBS
TX128539709Medicaid
TX128539709Medicaid
TX128539706Medicaid
TXTXB108091Medicare PIN
TXTXB109043Medicare PIN
00417RMedicare ID - Type Unspecified