1750388872 NPI number — DR. MARICAR GABORNE BELICENA-BADILLO M.D.

Table of content: DR. MARICAR GABORNE BELICENA-BADILLO M.D. (NPI 1750388872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750388872 NPI number — DR. MARICAR GABORNE BELICENA-BADILLO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELICENA-BADILLO
Provider First Name:
MARICAR
Provider Middle Name:
GABORNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750388872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 BECKS WOODS DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAR
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19701-3853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-261-5600
Provider Business Mailing Address Fax Number:
302-836-4302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 BECKS WOODS DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAR
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19701-3853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-261-5600
Provider Business Practice Location Address Fax Number:
302-836-4302
Provider Enumeration Date:
07/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  C1-0006184 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1000002084 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8410 . This is a "MID-ATLANTIC PROVIDER NUM" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 265-6388 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 271639 . This is a "COVENTRY PROVIDER NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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