Provider Demographics
NPI:1952560435
Name:BELLAVIA, IRM (MD)
Entity Type:Individual
Prefix:DR
First Name:IRM
Middle Name:
Last Name:BELLAVIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11111 CARMEL COMMONS BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5319
Mailing Address - Country:US
Mailing Address - Phone:704-540-1488
Mailing Address - Fax:704-540-0195
Practice Address - Street 1:11111 CARMEL COMMONS BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5319
Practice Address - Country:US
Practice Address - Phone:704-540-1488
Practice Address - Fax:704-540-0195
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2002006412084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry