=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891737565
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWIN HARRY BELLIS III M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32071 BEAVER RUN DR SUITE B
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21804-1773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-546-6322
-----------------------------------------------------
Fax | 410-546-6324
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32071 BEAVER RUN DR SUITE B
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21804-1773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-546-6322
-----------------------------------------------------
Fax | 410-546-6324
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number | D28587
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------