Healthcare Provider Details

I. General information

NPI: 1265467112
Provider Name (Legal Business Name): CHERRY BELLOSILLO LOBATON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/28/2021
Certification Date: 02/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 SUSHRUTA DR STE D
MARTINSBURG WV
25401-8898
US

IV. Provider business mailing address

220 CAMPUS BLVD STE 100
WINCHESTER VA
22601-2888
US

V. Phone/Fax

Practice location:
  • Phone: 304-262-2538
  • Fax: 304-262-2583
Mailing address:
  • Phone: 540-536-5100
  • Fax: 540-536-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19515
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: