Provider Demographics
NPI:1881627214
Name:BELCHER, SALLY JO (MD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:JO
Last Name:BELCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13208 MORAN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3923
Mailing Address - Country:US
Mailing Address - Phone:301-519-1670
Mailing Address - Fax:
Practice Address - Street 1:9715 MEDICAL CENTER DR STE 501
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3356
Practice Address - Country:US
Practice Address - Phone:301-738-0300
Practice Address - Fax:301-738-1316
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD51936207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD51936OtherLICENSE NUMBER
MD00A559S62Medicare PIN
F77402Medicare UPIN