Healthcare Provider Details

I. General information

NPI: 1346206976
Provider Name (Legal Business Name): KENNETH THOMAS BELLIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839 QUIET COVE
FAYETTEVILLE NC
28304-3857
US

IV. Provider business mailing address

1839 QUIET COVE
FAYETTEVILLE NC
28304-3857
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-1463
  • Fax: 910-323-1463
Mailing address:
  • Phone: 910-323-1463
  • Fax: 910-323-1575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number00189
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: