Provider Demographics
NPI:1003918749
Name:PRAIRIE, BETH ANN (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:PRAIRIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 LIBERTY AVE STE GR30
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-854-7140
Mailing Address - Fax:412-854-7142
Practice Address - Street 1:4815 LIBERTY AVE STE GR30
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-854-7140
Practice Address - Fax:412-854-7142
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433642207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102178806Medicaid
PA102178806Medicaid