MEDICARE: MRS. BETSY G RACE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD064080L	PA

General Provider Information

NPI Number	:	1710948401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETSY G RACE MD

Provider Business Mailing Address
First Line	:	100 GRANITE DR
Second Line	:	SUITE 200
City	:	MEDIA
State	:	PA
Zip	:	19063-5134
Country	:	US
Telephone Number	:	610-565-1945
Fax Number	:	610-892-7848

Provider Business Practice Location Address
First Line	:	100 GRANITE DR
Second Line	:	SUITE 200
City	:	MEDIA
State	:	PA
Zip	:	19063-5134
Country	:	US
Telephone Number	:	610-565-1945
Fax Number	:	610-892-7848

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	07/08/2007

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