Provider Demographics
NPI:1740294669
Name:PASCAL, BETH L (PA-C)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:L
Last Name:PASCAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14812 BOTANY WAY
Mailing Address - Street 2:
Mailing Address - City:N POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-4204
Mailing Address - Country:US
Mailing Address - Phone:301-251-6675
Mailing Address - Fax:
Practice Address - Street 1:575 MAIN ST
Practice Address - Street 2:351
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4343
Practice Address - Country:US
Practice Address - Phone:301-498-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001838363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD009617D14Medicare ID - Type Unspecified
MDP63397Medicare UPIN