Provider Demographics
NPI:1689629826
Name:BELFIELD MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:BELFIELD MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BUSILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-394-9934
Mailing Address - Street 1:3001 GARRETT RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2201
Mailing Address - Country:US
Mailing Address - Phone:610-394-9934
Mailing Address - Fax:610-394-2595
Practice Address - Street 1:3001 GARRETT RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-2201
Practice Address - Country:US
Practice Address - Phone:610-394-9934
Practice Address - Fax:610-394-2595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA068861Medicare PIN