Provider Demographics
NPI:1811156961
Name:JOLLY, BETH L (MD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:L
Last Name:JOLLY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2030 THISTLE HILL DR STE 202
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:PA
Practice Address - Zip Code:17362-1161
Practice Address - Country:US
Practice Address - Phone:717-843-7348
Practice Address - Fax:717-771-5393
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2024-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4454632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1811156961Medicaid