Provider Demographics
NPI:1740749043
Name:MCBETH, DEMITRI JAMES
Entity type:Individual
Prefix:MR
First Name:DEMITRI
Middle Name:JAMES
Last Name:MCBETH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 HOYLE DR APT B
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-2767
Mailing Address - Country:US
Mailing Address - Phone:716-861-6914
Mailing Address - Fax:
Practice Address - Street 1:4900 HOYLE DR APT B
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-2767
Practice Address - Country:US
Practice Address - Phone:716-861-6914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-16
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)