Healthcare Provider Details

I. General information

NPI: 1205812716
Provider Name (Legal Business Name): LITO J. BELARDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 MASSILLON RD STE 250
UNIONTOWN OH
44685-7854
US

IV. Provider business mailing address

PO BOX 639295 DEPT 93394
CINCINNATI OH
45263-9295
US

V. Phone/Fax

Practice location:
  • Phone: 248-434-6169
  • Fax:
Mailing address:
  • Phone: 248-434-6169
  • Fax: 855-618-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35068185
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: