Provider Demographics
NPI:1659318392
Name:BEITLE, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:BEITLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 NAYATT PT UNIT E
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-3337
Mailing Address - Country:US
Mailing Address - Phone:401-274-1533
Mailing Address - Fax:
Practice Address - Street 1:235 PLAIN ST STE 101A
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3242
Practice Address - Country:US
Practice Address - Phone:401-274-1533
Practice Address - Fax:401-369-7210
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156881207V00000X
RIMD9135207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIG69060Medicare UPIN