MEDICARE: DR. EDWIN HARRY BELLIS III 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	208VP0014X	Interventional Pain Medicine Physician	D28587	MD

General Provider Information

NPI Number	:	1891737565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWIN HARRY BELLIS III M.D.

Provider Business Mailing Address
First Line	:	32071 BEAVER RUN DR
Second Line	:	SUITE B
City	:	SALISBURY
State	:	MD
Zip	:	21804-1773
Country	:	US
Telephone Number	:	410-546-6322
Fax Number	:	410-546-6324

Provider Business Practice Location Address
First Line	:	32071 BEAVER RUN DR
Second Line	:	SUITE B
City	:	SALISBURY
State	:	MD
Zip	:	21804-1773
Country	:	US
Telephone Number	:	410-546-6322
Fax Number	:	410-546-6324

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

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	07/08/2007

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