Healthcare Provider Details

I. General information

NPI: 1225348683
Provider Name (Legal Business Name): ZELALEM A BELAYNEH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 SCARBRO ROAD
SCARBRO WV
25917-0337
US

IV. Provider business mailing address

908 SCARBRO ROAD PO BOX 337
SCARBRO WV
25917-0337
US

V. Phone/Fax

Practice location:
  • Phone: 304-469-2905
  • Fax: 304-465-3180
Mailing address:
  • Phone: 304-574-3960
  • Fax: 304-574-2179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number517
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: