Provider Demographics
NPI:1497108096
Name:BELACHEW, ANTENEH
Entity Type:Individual
Prefix:
First Name:ANTENEH
Middle Name:
Last Name:BELACHEW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANTENEH
Other - Middle Name:
Other - Last Name:BELACHEW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:11200 LOCKWOOD DR APT 220
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11200 LOCKWOOD DR APT 220
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4525
Practice Address - Country:US
Practice Address - Phone:855-633-0231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR221844367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered