Provider Demographics
NPI:1740312230
Name:BEATO, GREGORY CARL (DO)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:CARL
Last Name:BEATO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-0391
Mailing Address - Country:US
Mailing Address - Phone:540-951-3311
Mailing Address - Fax:540-552-8564
Practice Address - Street 1:810 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7023
Practice Address - Country:US
Practice Address - Phone:540-951-3311
Practice Address - Fax:540-552-8564
Is Sole Proprietor?:No
Enumeration Date:2007-03-10
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202249207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1740312230Medicaid
VA1740312230Medicaid