1902224371 NPI number — WESTON BETTNER MD

Table of content: WESTON BETTNER MD (NPI 1902224371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902224371 NPI number — WESTON BETTNER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BETTNER
Provider First Name:
WESTON
Provider Middle Name:
Provider Name Prefix Text:
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:
1902224371
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2566 HAYMAKER RD STE 311
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROEVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15146-3555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-359-8900
Provider Business Mailing Address Fax Number:
412-359-8977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2566 HAYMAKER RD STE 311
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15146-3555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-359-8900
Provider Business Practice Location Address Fax Number:
412-359-8977
Provider Enumeration Date:
04/02/2014

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: 207RG0100X , with the licence number:  MD460543 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 14655946 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".