Provider Demographics
NPI:1346555067
Name:HARPER, BETHANY LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:LEIGH
Last Name:HARPER
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:PO BOX 933421
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0039
Mailing Address - Country:US
Mailing Address - Phone:937-641-3000
Mailing Address - Fax:
Practice Address - Street 1:627 S. EDWIN C. MOSES BLVD.
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY, WRIGHT STATE UNIVERSITY
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45408-1461
Practice Address - Country:US
Practice Address - Phone:937-223-8840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1227842084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0120732Medicaid