Provider Demographics
NPI:1043043060
Name:BELLOTTE, SAMUEL J
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:J
Last Name:BELLOTTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 KRAMER DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-4264
Mailing Address - Country:US
Mailing Address - Phone:304-709-2209
Mailing Address - Fax:
Practice Address - Street 1:159 KRAMER DR
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-4264
Practice Address - Country:US
Practice Address - Phone:304-709-2209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVUD001455404001252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency