Healthcare Provider Details

I. General information

NPI: 1912482787
Provider Name (Legal Business Name): BELONGING MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 S MAIN ST STE 2
HANOVER NH
03755-2099
US

IV. Provider business mailing address

PO BOX 5518
HANOVER NH
03755-5518
US

V. Phone/Fax

Practice location:
  • Phone: 866-679-0831
  • Fax: 802-332-3117
Mailing address:
  • Phone: 866-679-0831
  • Fax: 802-332-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN DOUGLAS KELLY
Title or Position: TREASURER
Credential:
Phone: 866-679-0831