Provider Demographics
NPI:1003865759
Name:BELTOWSKI, DENISE L (PAC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:BELTOWSKI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 WILSON ST STE 109
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-3650
Mailing Address - Country:US
Mailing Address - Phone:717-249-1929
Mailing Address - Fax:717-249-9332
Practice Address - Street 1:220 WILSON ST STE 109
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3650
Practice Address - Country:US
Practice Address - Phone:717-249-1929
Practice Address - Fax:717-249-9332
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001876L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50010064OtherCAPITAL BCBS
PA072968Medicare PIN
PAP00108460Medicare PIN
PA50010064OtherCAPITAL BCBS
PA67804Medicare ID - Type Unspecified