Provider Demographics
NPI:1922118744
Name:BEATTIE, MARY STANLEY (MD, MAS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:STANLEY
Last Name:BEATTIE
Suffix:
Gender:F
Credentials:MD, MAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 FRONTERA WAY
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-2922
Mailing Address - Country:US
Mailing Address - Phone:415-885-7788
Mailing Address - Fax:
Practice Address - Street 1:2356 SUTTER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3006
Practice Address - Country:US
Practice Address - Phone:415-885-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGO79649207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine