Provider Demographics
NPI:1558317461
Name:LEVY, BETH K (MD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:K
Last Name:LEVY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:KESSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 PIPER HILL DR
Mailing Address - Street 2:STE 12
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1690
Mailing Address - Country:US
Mailing Address - Phone:636-244-4205
Mailing Address - Fax:636-244-4209
Practice Address - Street 1:112 PIPER HILL DR
Practice Address - Street 2:STE 12
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1690
Practice Address - Country:US
Practice Address - Phone:636-244-4205
Practice Address - Fax:636-244-4209
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2G62207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOB18561Medicare UPIN