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General NPI Number Information
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NPI Number | 1063501161
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Entity Type | Individual
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Provider Name | ANDREA L BELASCO MD
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 110 PARK AVE # 3
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City | SWARTHMORE
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State | PA
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Zip | 19081-1724
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Country | US
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Telephone | 610-328-4445
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Fax | 610-328-7514
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Provider Business Mailing Address
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Address Line | 236 BENJAMIN WEST AVE
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City | SWARTHMORE
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State | PA
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Zip | 19081-1421
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Country | US
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Telephone | 610-328-4445
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Fax | 610-328-7514
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD-025256-E
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License Number State | PA
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