Provider Demographics
NPI:1306151352
Name:BELASCO, JON R (DO)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:R
Last Name:BELASCO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1 NOLTE DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-7111
Mailing Address - Country:US
Mailing Address - Phone:724-543-5919
Mailing Address - Fax:724-543-3544
Practice Address - Street 1:1 NOLTE DR BLDG 100
Practice Address - Street 2:SUITE 150
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7111
Practice Address - Country:US
Practice Address - Phone:724-543-5919
Practice Address - Fax:724-543-3544
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-15
Last Update Date:2012-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS015495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10257959500001Medicaid