Healthcare Provider Details

I. General information

NPI: 1053052266
Provider Name (Legal Business Name): NICHOLAS BELLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 SECOND STREET PIKE
SOUTHAMPTON PA
18966-3812
US

IV. Provider business mailing address

319 SECOND STREET PIKE
SOUTHAMPTON PA
18966-3812
US

V. Phone/Fax

Practice location:
  • Phone: 215-788-3504
  • Fax:
Mailing address:
  • Phone: 215-355-4428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD494152
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: