Provider Demographics
NPI:1841275203
Name:BEATTY, TRICIA MICHELE (DO)
Entity type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:MICHELE
Last Name:BEATTY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TRICIA
Other - Middle Name:BEATTY
Other - Last Name:SLATTERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-0305
Mailing Address - Country:US
Mailing Address - Phone:610-601-9177
Mailing Address - Fax:610-601-9168
Practice Address - Street 1:3537 WEST CHESTER PIKE
Practice Address - Street 2:OPTIONAL
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3701
Practice Address - Country:US
Practice Address - Phone:610-601-9177
Practice Address - Fax:610-601-9168
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014981207QS0010X
NJ25 MB08780800207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine