Healthcare Provider Details

I. General information

NPI: 1851481923
Provider Name (Legal Business Name): KIRSTEN BELLUCCI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S CEDAR CREST BLVD DEPARTMENT OF PATHOLOGY/HEALTH NETWORK LABORATORIES
ALLENTOWN PA
18103-6202
US

IV. Provider business mailing address

1200 S CEDAR CREST BLVD DEPARTMENT OF PATHOLOGY/HEALTH NETWORK LABORATORIES
ALLENTOWN PA
18103-6202
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-8140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD420593
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD420593
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: