Healthcare Provider Details

I. General information

NPI: 1528604956
Provider Name (Legal Business Name): MARK ANTHONY BELILL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MEDICAL ARTS AVE NE
ALBUQUERQUE NM
87102-2706
US

IV. Provider business mailing address

PO BOX 1094
PLACITAS NM
87043-1094
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2273
  • Fax:
Mailing address:
  • Phone: 505-515-5714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberPA2019-0103
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: