Provider Demographics
NPI:1265409882
Name:BELLUCCI, BENJAMIN WILLIAM (IDMT, NREMT)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:WILLIAM
Last Name:BELLUCCI
Suffix:
Gender:M
Credentials:IDMT, NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMDT (CG-1122)
Mailing Address - Street 2:US COAST GUARD 2100 2ND ST SW SUITE 5314
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:COMDT (CG-1122)
Practice Address - Street 2:US COAST GUARD 2100 2ND ST SW SUITE 5314
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-0001
Practice Address - Country:US
Practice Address - Phone:585-919-6602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other