Provider Demographics
NPI:1124022645
Name:BERRETTONI, BETH ANNE (MD)
Entity Type:Individual
Prefix:
First Name:BETH ANNE
Middle Name:
Last Name:BERRETTONI
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 1:2350 MIAMI VALLEY DR
Mailing Address - Street 2:STE 310
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4778
Mailing Address - Country:US
Mailing Address - Phone:937-435-4263
Mailing Address - Fax:937-298-9459
Practice Address - Street 1:2350 MIAMI VALLEY DR
Practice Address - Street 2:STE 310
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4778
Practice Address - Country:US
Practice Address - Phone:937-435-4263
Practice Address - Fax:937-298-9459
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054146207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH09-20041OtherUNITED HEALTHCARE
OHD54146OtherCHOICE CARE
OH000000013732OtherANTHEM
OH0878019Medicaid
OH09-20041OtherUNITED HEALTHCARE
OHD54146OtherCHOICE CARE
OHBE0718501Medicare ID - Type Unspecified