Provider Demographics
NPI:1306929435
Name:BEARELLY, DILIP (MD)
Entity type:Individual
Prefix:
First Name:DILIP
Middle Name:
Last Name:BEARELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1305
Mailing Address - Fax:937-522-7513
Practice Address - Street 1:520 EATON AVE STE 100
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2716
Practice Address - Country:US
Practice Address - Phone:513-896-2200
Practice Address - Fax:513-894-0096
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007022716207R00000X, 207RG0100X
OH35.125020207RG0100X
PAMD428129207R00000X
LAMD.203986208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02236857Medicaid
LA2118153Medicaid
OH0117444Medicaid
MO204466304Medicaid
OHH443370Medicare PIN
LA2118153Medicaid
LA4P3137061Medicare PIN
MOP00415507Medicare PIN
MO324861444Medicare PIN