Provider Demographics
NPI:1811142508
Name:BELUCH, BRIAN WALTER (DO)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:WALTER
Last Name:BELUCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1A REGULUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012
Mailing Address - Country:US
Mailing Address - Phone:844-542-2273
Mailing Address - Fax:
Practice Address - Street 1:2300 COMPUTER RD STE H39
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1740
Practice Address - Country:US
Practice Address - Phone:215-657-5200
Practice Address - Fax:215-657-8083
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08878700207RE0101X
PAOS018865207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103334128Medicaid
NJ0265296Medicaid
NJ0265296Medicaid