MEDICARE: DR. BELA SHESTOPALOVA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D0051477	MD
2	207R00000X	Internal Medicine Physician	0101055158	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205918802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BELA SHESTOPALOVA M.D.

Provider Business Mailing Address
First Line	:	12405 GLEN MILL RD
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854-1908
Country	:	US
Telephone Number	:	301-717-3355
Fax Number	:	202-318-0745

Provider Business Practice Location Address
First Line	:	1105 SPRING ST STE G
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4026
Country	:	US
Telephone Number	:	301-588-1181
Fax Number	:	301-588-0483

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	02/07/2012

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