Provider Demographics
NPI:1336133305
Name:HANRAHAN, BETH A (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:HANRAHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 N BELCHER RD STE G1
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1453
Mailing Address - Country:US
Mailing Address - Phone:727-724-9656
Mailing Address - Fax:727-725-8589
Practice Address - Street 1:1831 N BELCHER RD STE G1
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1453
Practice Address - Country:US
Practice Address - Phone:727-724-9656
Practice Address - Fax:727-725-8589
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065008207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23730AMedicare ID - Type Unspecified
E84783Medicare UPIN