Provider Demographics
NPI:1093724890
Name:BETESH, JOEL SAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:SAM
Last Name:BETESH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOEL
Other - Middle Name:SAM
Other - Last Name:BETESH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2240 S 3RD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-3347
Mailing Address - Country:US
Mailing Address - Phone:215-755-8575
Mailing Address - Fax:215-271-8323
Practice Address - Street 1:2240 S 3RD ST FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-3347
Practice Address - Country:US
Practice Address - Phone:215-755-8575
Practice Address - Fax:215-271-8323
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021552E207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA153140Medicare PIN
B40024Medicare UPIN
BE153140Medicare ID - Type Unspecified