Provider Demographics
NPI:1316001043
Name:BEATTY, JULIA D (MD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:D
Last Name:BEATTY
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 1:5200 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-9741
Mailing Address - Country:US
Mailing Address - Phone:513-248-8997
Mailing Address - Fax:513-297-5107
Practice Address - Street 1:5200 BEECHWOOD RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-9741
Practice Address - Country:US
Practice Address - Phone:513-248-8997
Practice Address - Fax:513-297-5107
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-085757207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2821941Medicaid
35-085757OtherOH STATE MEDICAL LICENSE
OHBR9121613OtherDEA
35-085757OtherOH STATE MEDICAL LICENSE
OH2821941Medicaid