Provider Demographics
NPI:1982231528
Name:BELLO, BOSEDE (MED)
Entity Type:Individual
Prefix:
First Name:BOSEDE
Middle Name:
Last Name:BELLO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3249 PURPLE LEAF LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-6132
Mailing Address - Country:US
Mailing Address - Phone:301-755-3882
Mailing Address - Fax:
Practice Address - Street 1:3249 PURPLE LEAF LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-6132
Practice Address - Country:US
Practice Address - Phone:301-755-3882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator