1235126715 NPI number — DR. MARTIN F BETTS MD

Table of content: DR. MARTIN F BETTS MD (NPI 1235126715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235126715 NPI number — DR. MARTIN F BETTS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BETTS
Provider First Name:
MARTIN
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235126715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8266
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23226-0266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-285-0100
Provider Business Mailing Address Fax Number:
804-285-2458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 GLENSIDE DR
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23226-3769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-285-0100
Provider Business Practice Location Address Fax Number:
804-285-2458
Provider Enumeration Date:
09/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  0101029467 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 141612 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2744922 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 250801 . This is a "MAMSI/ALLIANCE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 286955 . This is a "ANTHEM-HANOVER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 50476 . This is a "CARENET" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 027877 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4063288 . This is a "AETNA NONHMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 286954 . This is a "ANTHEM-GLENSIDE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 290014186 . This is a "MEDICARE-RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 21261 . This is a "SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5864381 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04-04701 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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