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NPI Code Detail

MEDICARE: MATEO JOSE BETANCOURT D.O.

MEDICARE: MATEO JOSE BETANCOURT D.O.
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
1208D00000XGeneral Practice Physician0102205620VA
2390200000XStudent in an Organized Health Care Education/Training Program
3208000000XPediatrics PhysicianH0101595MD

General Provider Information

NPI Number : 1801329362
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATEO JOSE BETANCOURT D.O.
Provider Business Mailing Address
First Line : 8910 OLD MONTGOMERY RD
Second Line :
City : COLUMBIA
State : MD
Zip : 21045-4239
Country : US
Telephone Number : 210-478-8360
Fax Number :
Provider Business Practice Location Address
First Line : 6830 HOSPITAL DR STE 206
Second Line :
City : ROSEDALE
State : MD
Zip : 21237-4377
Country : US
Telephone Number : 410-238-5390
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2017
Last Update Date : 07/15/2025

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