Provider Demographics
NPI:1710948401
Name:RACE, BETSY G (MD)
Entity Type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:G
Last Name:RACE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 GRANITE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5134
Mailing Address - Country:US
Mailing Address - Phone:610-565-1945
Mailing Address - Fax:610-892-7848
Practice Address - Street 1:100 GRANITE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5134
Practice Address - Country:US
Practice Address - Phone:610-565-1945
Practice Address - Fax:610-892-7848
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD064080L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G87903Medicare UPIN