Provider Demographics
NPI:1720346752
Name:BELLAN, JASON R (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:R
Last Name:BELLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:110 N 19TH ST UNIT 1A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7282
Mailing Address - Country:US
Mailing Address - Phone:617-314-7865
Mailing Address - Fax:617-314-9013
Practice Address - Street 1:110 N 19TH ST UNIT 1A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7282
Practice Address - Country:US
Practice Address - Phone:617-314-7865
Practice Address - Fax:617-314-9013
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program