Provider Demographics
NPI:1619902525
Name:BEFEKADU, BELAYENH (MD)
Entity Type:Individual
Prefix:
First Name:BELAYENH
Middle Name:
Last Name:BEFEKADU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1352 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-2606
Mailing Address - Country:US
Mailing Address - Phone:336-342-3338
Mailing Address - Fax:336-342-9762
Practice Address - Street 1:1352 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-2606
Practice Address - Country:US
Practice Address - Phone:336-342-3338
Practice Address - Fax:336-342-9762
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500507207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3102113OtherUNITED HEALTHCARE
NC11593OtherPARTNERS
NC58355OtherMEDCOST
NC8914370Medicaid
NC14370OtherBCBS
NC390005414OtherRAILROAD MEDICARE
VA5811953OtherVIRGINIA MEDICAID
NCF63368Medicare UPIN
VA5811953OtherVIRGINIA MEDICAID