MEDICARE: DELBELLO, LLC

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	01037213	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110175714	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	4134142	OTHER		AETNA
3	1220	OTHER		PHYSICIANS HEALTH PLAN
4	000000527354	OTHER	IN	ANTHEM
5	0462448	OTHER		CIGNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902946494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELBELLO, LLC

Provider Business Mailing Address
First Line	:	PO BOX 715375
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43271-5375
Country	:	US
Telephone Number	:	260-969-1950
Fax Number	:	260-918-2137

Provider Business Practice Location Address
First Line	:	3124 E STATE BLVD
Second Line	:	SUITE 3F
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-4763
Country	:	US
Telephone Number	:	260-482-1681
Fax Number	:	260-482-1857

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK W DELBELLO
Credential	:	MD
Telephone Number	:	260-482-1681

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	06/29/2011

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Directions to “DELBELLO, LLC ” Practice Location

Language	Start Address	Practice Location

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