Provider Demographics
NPI:1013139070
Name:BEATTY, TEAL HARVEY (CAC, MAC, LAC)
Entity Type:Individual
Prefix:
First Name:TEAL
Middle Name:HARVEY
Last Name:BEATTY
Suffix:
Gender:F
Credentials:CAC, MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9610 BALTIMORE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723
Mailing Address - Country:US
Mailing Address - Phone:410-746-1960
Mailing Address - Fax:301-317-4704
Practice Address - Street 1:377 MAIN ST,
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707
Practice Address - Country:US
Practice Address - Phone:410-746-1960
Practice Address - Fax:301-317-4704
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist