=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356895510
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MORGAN BELLIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2016
-----------------------------------------------------
Last Update Date | 02/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 833 CHESTNUT ST SUITE 1402
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107-4414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-321-9999
-----------------------------------------------------
Fax | 267-337-3761
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 DELANCEY ST UNIT 3
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19103-6539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-321-9999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | MA058166
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------