Provider Demographics
NPI:1134389414
Name:WENDY VAN BELLINGHAM, MD PC
Entity type:Organization
Organization Name:WENDY VAN BELLINGHAM, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN BELLINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-229-7274
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-0200
Mailing Address - Country:US
Mailing Address - Phone:518-229-7274
Mailing Address - Fax:518-348-1279
Practice Address - Street 1:1659 CENTRAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-4039
Practice Address - Country:US
Practice Address - Phone:518-229-7274
Practice Address - Fax:518-348-1279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167992207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00984405Medicaid
NYE51425Medicare UPIN