Provider Demographics
NPI:1689605693
Name:BETH HANRAHAN MD LLC
Entity Type:Organization
Organization Name:BETH HANRAHAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HANRAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-724-9656
Mailing Address - Street 1:1831 N BELCHER RD STE G1
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1453
Mailing Address - Country:US
Mailing Address - Phone:727-724-9656
Mailing Address - Fax:
Practice Address - Street 1:1831 N BELCHER RD STE G1
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1453
Practice Address - Country:US
Practice Address - Phone:727-724-9656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065008207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE84783Medicare UPIN
FL23730AMedicare ID - Type Unspecified