Provider Demographics
NPI:1952360018
Name:BEATTY, RANDALL L (MD)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:L
Last Name:BEATTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 EAST NORTH AVENUE
Mailing Address - Street 2:STE 116
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212
Mailing Address - Country:US
Mailing Address - Phone:412-359-6300
Mailing Address - Fax:412-359-6768
Practice Address - Street 1:420 EAST NORTH AVENUE
Practice Address - Street 2:STE 116
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212
Practice Address - Country:US
Practice Address - Phone:412-359-6300
Practice Address - Fax:412-359-6768
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035132E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012532240006Medicaid
F10465Medicare UPIN
678841J4EMedicare ID - Type Unspecified