Provider Demographics
NPI:1982726428
Name:BELLEFONTE MEDICAL CLINIC P.C.
Entity Type:Organization
Organization Name:BELLEFONTE MEDICAL CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOUL-HOSN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-353-3337
Mailing Address - Street 1:527 WILLOWBANK ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-1327
Mailing Address - Country:US
Mailing Address - Phone:814-353-3337
Mailing Address - Fax:
Practice Address - Street 1:527 WILLOWBANK ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-1327
Practice Address - Country:US
Practice Address - Phone:814-353-3337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-034777E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010519440003Medicaid
PA163573Medicare PIN
PAB41443Medicare UPIN