Provider Demographics
NPI:1518169846
Name:DR SAMUEL D BEITLER PA
Entity Type:Organization
Organization Name:DR SAMUEL D BEITLER PA
Other - Org Name:SAMUEL D BEITLER DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:BEITLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM PA
Authorized Official - Phone:410-768-0702
Mailing Address - Street 1:795 AQUAHART ROAD
Mailing Address - Street 2:SUITE NUMBER 125
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:410-768-0702
Mailing Address - Fax:410-768-0649
Practice Address - Street 1:795 AQUAHART ROAD
Practice Address - Street 2:SUITE NUMBER 125
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-768-0702
Practice Address - Fax:410-768-0649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD445332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0652170001Medicare NSC