Provider Demographics
NPI:1528019213
Name:BEETLESTONE, CLAIRE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:ANN
Last Name:BEETLESTONE
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 1:463 GREENOUGH RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-5305
Mailing Address - Country:US
Mailing Address - Phone:607-547-9067
Mailing Address - Fax:607-547-6073
Practice Address - Street 1:7 DRIFTWAY
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-4671
Practice Address - Country:US
Practice Address - Phone:781-545-7071
Practice Address - Fax:781-545-7712
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA508032085R0202X
NY139839-1208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A67649Medicare UPIN