Healthcare Provider Details

I. General information

NPI: 1457314122
Provider Name (Legal Business Name): TERRY ALAN BELLES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 SHAFFER ST
SOUTH WILLIAMSPORT PA
17702-6727
US

IV. Provider business mailing address

1201 GRAMPIAN BLVD SUITE 1K
WILLIAMSPORT PA
17701-1900
US

V. Phone/Fax

Practice location:
  • Phone: 570-326-2447
  • Fax: 570-326-1247
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD018667E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: