Provider Demographics
NPI:1205803616
Name:BETHUY, JOSEPH A (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:BETHUY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 BELMONT AVE
Mailing Address - Street 2:SUITES 13 & 14
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1450
Mailing Address - Country:US
Mailing Address - Phone:330-759-6888
Mailing Address - Fax:330-759-8028
Practice Address - Street 1:3622 BELMONT AVE
Practice Address - Street 2:SUITES 13 & 14
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1450
Practice Address - Country:US
Practice Address - Phone:330-759-6888
Practice Address - Fax:330-759-8028
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051211B208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0602824Medicaid
OH00000015983OtherUNISON
OH1542954OtherGATEWAY
OH341942845026OtherCARESOURCE
OHANTHEMOther000000190779
OHA16732Medicare UPIN