Provider Demographics
NPI:1568510519
Name:BEYER, MARK D (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:BEYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 HULLCREST BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756-5794
Mailing Address - Country:US
Mailing Address - Phone:570-649-5143
Mailing Address - Fax:
Practice Address - Street 1:215 E WATER ST
Practice Address - Street 2:MUNCY VALLEY HOSPITAL
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-8828
Practice Address - Country:US
Practice Address - Phone:570-546-4201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-006937-L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE43517Medicare UPIN