Provider Demographics
NPI:1104893395
Name:BELLANTONI, MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:BELLANTONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 ST PAUL ST
Mailing Address - Street 2:POB SUITE 505
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202
Mailing Address - Country:US
Mailing Address - Phone:410-332-9800
Mailing Address - Fax:410-385-9382
Practice Address - Street 1:301 ST PAUL ST
Practice Address - Street 2:SUITE 505
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202
Practice Address - Country:US
Practice Address - Phone:410-332-9800
Practice Address - Fax:410-385-9382
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046057207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD142421101Medicaid