Healthcare Provider Details

I. General information

NPI: 1215008677
Provider Name (Legal Business Name): ALSAN BELLARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ATLANTIC ST SW
WASHINGTON DC
20032-2350
US

IV. Provider business mailing address

4 ATLANTIC ST SW
WASHINGTON DC
20032-2350
US

V. Phone/Fax

Practice location:
  • Phone: 202-540-9857
  • Fax: 202-232-8494
Mailing address:
  • Phone: 202-540-9857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD30416
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: