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General NPI Number Information
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NPI Number | 1033705835
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Entity Type | Organization
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Legal Business Name | BELMONT FAMILY PRACTICE, INC.
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Dates
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Enumeration Date | 12/15/2020
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 1346 BELMONT AVE STE 602
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City | SALISBURY
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State | MD
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Zip | 21804-4589
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Country | US
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Telephone | 443-978-7317
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Fax | 443-736-4080
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Provider Business Mailing Address
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Address Line | 1346 BELMONT AVE STE 602
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City | SALISBURY
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State | MD
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Zip | 21804-4589
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Country | US
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Telephone | 443-978-7317
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Fax | 443-736-4080
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONNA MARIE GRAY
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Credential | CRNP
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Telephone | 443-978-7317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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