Provider Demographics
NPI:1801827209
Name:OVERMOYER, BETH A (MD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:A
Last Name:OVERMOYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:44 BINNEY ST
Mailing Address - Street 2:MAYER 220B
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6013
Mailing Address - Country:US
Mailing Address - Phone:617-632-3427
Mailing Address - Fax:617-632-1930
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:MAYER 220B
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6013
Practice Address - Country:US
Practice Address - Phone:617-632-3427
Practice Address - Fax:617-632-1930
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT043266207RH0003X
MA234514207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT043266OtherCT LICENSE
CT37091OtherCT CONTROLLED SUBSTANCE
CT37091OtherCT CONTROLLED SUBSTANCE
CT37091OtherCT CONTROLLED SUBSTANCE
BO1294886OtherDEA
CTP00400365Medicare PIN