Provider Demographics
NPI:1114045697
Name:M. DAVID BEITLE, M.D., INC
Entity Type:Organization
Organization Name:M. DAVID BEITLE, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:M. DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BEITLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-274-1533
Mailing Address - Street 1:695 EDDY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903
Mailing Address - Country:US
Mailing Address - Phone:401-274-1533
Mailing Address - Fax:401-369-7210
Practice Address - Street 1:695 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4941
Practice Address - Country:US
Practice Address - Phone:401-274-1533
Practice Address - Fax:401-369-7210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD09135207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIG69060Medicare UPIN