MEDICARE: DR. JESSICA HELEN BELCHOS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208600000X	Surgery Physician	01080924A	IN

General Provider Information

NPI Number	:	1215390943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA HELEN BELCHOS MD

Provider Business Mailing Address
First Line	:	11541 E WINCHESTER LN
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2040
Country	:	US
Telephone Number	:	317-274-7827
Fax Number	:	317-962-0289

Provider Business Practice Location Address
First Line	:	8240 NAAB RD STE 100
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1985
Country	:	US
Telephone Number	:	317-338-7450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2016
Last Update Date	:	08/30/2022

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