Healthcare Provider Details

I. General information

NPI: 1912192568
Provider Name (Legal Business Name): ROBERT L BELLUSO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CHAMBER PLZ
CHARLEROI PA
15022-1605
US

IV. Provider business mailing address

1070 OLD NATIONAL PIKE
FREDERICKTOWN PA
15333-2114
US

V. Phone/Fax

Practice location:
  • Phone: 724-483-5482
  • Fax: 724-483-5856
Mailing address:
  • Phone: 724-632-6801
  • Fax: 724-632-6312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS014501
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: