Provider Demographics
NPI:1053609339
Name:BELLO, ADEMOLA (MD)
Entity type:Individual
Prefix:
First Name:ADEMOLA
Middle Name:
Last Name:BELLO
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 1:448 WALTON AVE UNIT 68
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-4003
Mailing Address - Country:US
Mailing Address - Phone:646-494-6641
Mailing Address - Fax:
Practice Address - Street 1:448 WALTON AVE UNIT 68
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-4003
Practice Address - Country:US
Practice Address - Phone:646-494-6641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2948822084P0800X
VA01012717472084P0800X
PAMD4534212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103007984Medicaid
PA417124G9BMedicare PIN