Healthcare Provider Details

I. General information

NPI: 1275545907
Provider Name (Legal Business Name): PAULINE E BELLOS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 DOCTORS DR
GREENVILLE SC
29605-5608
US

IV. Provider business mailing address

111 DOCTORS DR
GREENVILLE SC
29605-5608
US

V. Phone/Fax

Practice location:
  • Phone: 864-797-7100
  • Fax: 864-797-7133
Mailing address:
  • Phone: 864-797-7100
  • Fax: 864-797-7133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number297
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: