Provider Demographics
NPI:1093859357
Name:BEITEL, DONNA LENORE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:LENORE
Last Name:BEITEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:LENORE
Other - Last Name:BEITEL-SMUTNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:813-1 CHESAPEAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-9401
Mailing Address - Country:US
Mailing Address - Phone:410-221-2266
Mailing Address - Fax:410-221-2878
Practice Address - Street 1:813-1 CHESAPEAKE DRIVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-9401
Practice Address - Country:US
Practice Address - Phone:410-221-2266
Practice Address - Fax:410-221-2878
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00558712084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD010618101OtherFED TAX ID #
MD15-32517OtherCOVENTRY
MD7592348OtherAETNA GROUP #
MD130801700Medicaid
MD264849OtherCOMPSYCH
MD479302100Medicaid
MDF793 0010OtherBCBS - FEDERAL
MDKBM9 60623102OtherBCBS- STATE
MD220946-000OtherMAGELLAN MIS#
MD733191OtherNCPPO
MD2128183OtherMAMSI INDIVIDUAL #
MD4540864OtherAETNA INDIVIDUAL #
MD388898OtherMAMSI GROUP #
MD010618101OtherFED TAX ID #