Provider Demographics
NPI:1831252956
Name:DAMTEW, BELAI (MD)
Entity type:Individual
Prefix:DR
First Name:BELAI
Middle Name:
Last Name:DAMTEW
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 1:30701 LORAIN RD STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-6325
Mailing Address - Country:US
Mailing Address - Phone:440-274-5000
Mailing Address - Fax:440-716-8608
Practice Address - Street 1:7255 OLD OAK BLVD
Practice Address - Street 2:BLDG C, SUITE 302
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3329
Practice Address - Country:US
Practice Address - Phone:440-816-4394
Practice Address - Fax:440-816-6755
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-052033207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000113874OtherANTHEM
OH1305865OtherUNITED HEALTHCARE
OH69548OtherQUALCHOICE
WV3810003607Medicaid
OH0666766Medicaid
OH69548OtherQUALCHOICE
OH0666766Medicaid
WV3810003607Medicaid