Healthcare Provider Details

I. General information

NPI: 1285610790
Provider Name (Legal Business Name): DIANE S. BELARDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7452 FULTON DR NW STE B
MASSILLON OH
44646-9393
US

IV. Provider business mailing address

7452 FULTON DR NW SUITE B
MASSILLON OH
44646-9393
US

V. Phone/Fax

Practice location:
  • Phone: 330-644-3747
  • Fax: 330-644-9815
Mailing address:
  • Phone: 330-833-4596
  • Fax: 330-833-1317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35067025
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: