Provider Demographics
NPI:1124558267
Name:BELCHENKO, DMITRY DMITRIYEVICH (DO)
Entity Type:Individual
Prefix:DR
First Name:DMITRY
Middle Name:DMITRIYEVICH
Last Name:BELCHENKO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7257 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2950
Mailing Address - Country:US
Mailing Address - Phone:559-227-7463
Mailing Address - Fax:559-451-3690
Practice Address - Street 1:7257 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2950
Practice Address - Country:US
Practice Address - Phone:559-227-7463
Practice Address - Fax:559-451-3690
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
NM390200000X
CA197372084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program