Provider Demographics
NPI:1790031003
Name:TAI, BELOFINE
Entity Type:Individual
Prefix:
First Name:BELOFINE
Middle Name:
Last Name:TAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 SHAMROCK AVE
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-5302
Mailing Address - Country:US
Mailing Address - Phone:240-602-3594
Mailing Address - Fax:
Practice Address - Street 1:1705 SHAMROCK AVE
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-5302
Practice Address - Country:US
Practice Address - Phone:240-602-3594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide