Provider Demographics
NPI:1952530438
Name:BELARDO, BETYSHIA J (MD)
Entity Type:Individual
Prefix:DR
First Name:BETYSHIA
Middle Name:J
Last Name:BELARDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BETYSHIA
Other - Middle Name:J
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5320 PROVIDENCE RD
Mailing Address - Street 2:STE 301
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4122
Mailing Address - Country:US
Mailing Address - Phone:757-413-7600
Mailing Address - Fax:757-507-9051
Practice Address - Street 1:5320 PROVIDENCE RD STE 301
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4122
Practice Address - Country:US
Practice Address - Phone:757-413-7600
Practice Address - Fax:757-507-9051
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120734207Q00000X
390200000X
VA0101254362207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program