Healthcare Provider Details

I. General information

NPI: 1952530438
Provider Name (Legal Business Name): BETYSHIA JEANITA WATSON BELARDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETYSHIA J WATSON MD

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 PROVIDENCE RD STE 301
VIRGINIA BEACH VA
23464-4122
US

IV. Provider business mailing address

5320 PROVIDENCE RD STE 301
VIRGINIA BEACH VA
23464-4122
US

V. Phone/Fax

Practice location:
  • Phone: 757-413-7600
  • Fax: 757-507-9051
Mailing address:
  • Phone: 757-413-7600
  • Fax: 757-507-9051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA120734
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101254362
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: