Healthcare Provider Details

I. General information

NPI: 1568434181
Provider Name (Legal Business Name): LEROY C BELL JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 MARYLAND AVE
BALTIMORE MD
21218-5634
US

IV. Provider business mailing address

14038 MONTICELLO DR
COOKSVILLE MD
21723-9614
US

V. Phone/Fax

Practice location:
  • Phone: 443-718-7343
  • Fax: 410-489-9356
Mailing address:
  • Phone: 410-489-9351
  • Fax: 410-489-9356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD38775
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD38775
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: