Healthcare Provider Details

I. General information

NPI: 1619902525
Provider Name (Legal Business Name): BELAYENH BEFEKADU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1352 W HARRISON ST
REIDSVILLE NC
27320-2606
US

IV. Provider business mailing address

1352 W HARRISON ST
REIDSVILLE NC
27320-2606
US

V. Phone/Fax

Practice location:
  • Phone: 336-342-3338
  • Fax: 336-342-9762
Mailing address:
  • Phone: 336-342-3338
  • Fax: 336-342-9762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number9500507
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: