Healthcare Provider Details

I. General information

NPI: 1972505618
Provider Name (Legal Business Name): ROBERT BELASCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 WEST GERMANTOWN PIKE MEDICAL ARTS BUILDING - SUITE #120
EAST NORRITON PA
19403
US

IV. Provider business mailing address

207 N BROAD ST 3RD FLOOR
PHILA PA
19107-1500
US

V. Phone/Fax

Practice location:
  • Phone: 610-279-1370
  • Fax: 610-279-1372
Mailing address:
  • Phone: 610-279-1370
  • Fax: 610-279-1372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD015526E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: