Healthcare Provider Details

I. General information

NPI: 1285648667
Provider Name (Legal Business Name): BRENDA KAREN PETTUS-BELLAMY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6915 LAUREL BOWIE RD SUITE 301
BOWIE MD
20715
US

IV. Provider business mailing address

3300 DUNWOOD RIDGE TERRACE
BOWIE MD
20721
US

V. Phone/Fax

Practice location:
  • Phone: 301-249-8838
  • Fax: 301-249-5334
Mailing address:
  • Phone: 301-218-1614
  • Fax: 301-218-1613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD33204
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: