Provider Demographics
NPI:1295261436
Name:SAMUEL D BEITLER
Entity type:Organization
Organization Name:SAMUEL D BEITLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BIETLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-768-0702
Mailing Address - Street 1:795 AQUAHART RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3962
Mailing Address - Country:US
Mailing Address - Phone:410-798-0707
Mailing Address - Fax:410-768-0649
Practice Address - Street 1:795 AQUAHART RD
Practice Address - Street 2:SUITE 125
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3962
Practice Address - Country:US
Practice Address - Phone:410-798-0707
Practice Address - Fax:410-768-0649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-09
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00445261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric