1093859357 NPI number — DR. DONNA LENORE BEITEL M.D.

Table of content: HOPE OSAGIE (NPI 1245790054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093859357 NPI number — DR. DONNA LENORE BEITEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEITEL
Provider First Name:
DONNA
Provider Middle Name:
LENORE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BEITEL-SMUTNY
Provider Other First Name:
DONNA
Provider Other Middle Name:
LENORE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093859357
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
813-1 CHESAPEAKE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21613-9401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-221-2266
Provider Business Mailing Address Fax Number:
410-221-2878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
813-1 CHESAPEAKE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21613-9401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-221-2266
Provider Business Practice Location Address Fax Number:
410-221-2878
Provider Enumeration Date:
02/19/2007

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: 2084P0804X , with the licence number:  D0055871 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010618101 . This is a "FED TAX ID #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 15-32517 . This is a "COVENTRY" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7592348 . This is a "AETNA GROUP #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 130801700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 264849 . This is a "COMPSYCH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 479302100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: F793 0010 . This is a "BCBS - FEDERAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: KBM9 60623102 . This is a "BCBS- STATE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 220946-000 . This is a "MAGELLAN MIS#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 733191 . This is a "NCPPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2128183 . This is a "MAMSI INDIVIDUAL #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4540864 . This is a "AETNA INDIVIDUAL #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 388898 . This is a "MAMSI GROUP #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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