Provider Demographics
NPI:1720011570
Name:REYES-BELTRAN, ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:REYES-BELTRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANTIONIO
Other - Middle Name:
Other - Last Name:REYES-BELTRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 OAKRIDGE BLVD STE C1
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2351
Practice Address - Country:US
Practice Address - Phone:910-738-9414
Practice Address - Fax:910-738-1012
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057995207RP1001X, 207RS0012X
NC2019-01727207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA291798742AMedicaid
GA11SCGFTMedicare PIN
GA291798742AMedicaid