Provider Demographics
NPI:1003865759
Name:BELTOWSKI, DENISE L (PAC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:BELTOWSKI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13620 CRAYTON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2335
Mailing Address - Country:US
Mailing Address - Phone:240-313-3100
Mailing Address - Fax:
Practice Address - Street 1:13620 CRAYTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2335
Practice Address - Country:US
Practice Address - Phone:240-313-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002198363A00000X
PAMA001876L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50010064OtherCAPITAL BCBS
PA072968Medicare PIN
PAP00108460Medicare PIN
PA50010064OtherCAPITAL BCBS
PA67804Medicare ID - Type Unspecified