Provider Demographics
NPI:1689671422
Name:MAXWELL, BETH A (MD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:A
Last Name:MAXWELL
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 1:520 JEFFERSON AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-2538
Mailing Address - Country:US
Mailing Address - Phone:724-527-8060
Mailing Address - Fax:724-522-4002
Practice Address - Street 1:1010 LIGONIER ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1882
Practice Address - Country:US
Practice Address - Phone:724-539-8581
Practice Address - Fax:724-539-2739
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044079E174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA433379OtherBLUE SHIELD
PA203714OtherUPMC
PA0011723780001Medicaid
PA1006787OtherGATEWAY
PA64470OtherTHREE RIVERS-MEDPLUS
PA35136OtherHEALTH AMERICA/HEALTH ASS
PA0011723780001Medicaid
PA35136OtherHEALTH AMERICA/HEALTH ASS