Provider Demographics
NPI:1396958153
Name:ARTURO BETANCOURT, M.D., P.A.
Entity type:Organization
Organization Name:ARTURO BETANCOURT, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTURO
Authorized Official - Middle Name:R
Authorized Official - Last Name:BETANCOURT
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:410-766-3937
Mailing Address - Street 1:200 HOSPITAL DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5884
Mailing Address - Country:US
Mailing Address - Phone:410-766-3937
Mailing Address - Fax:410-761-4386
Practice Address - Street 1:200 HOSPITAL DR
Practice Address - Street 2:SUITE 600
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5884
Practice Address - Country:US
Practice Address - Phone:410-766-3937
Practice Address - Fax:410-761-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332H00000X
MDD0036550207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1202530001OtherDMERC
MD605221500Medicaid
MD494LMedicare PIN
1202530001OtherDMERC