Healthcare Provider Details

I. General information

NPI: 1851479877
Provider Name (Legal Business Name): PATRICK A BEITER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7829 LAUREL AVE
CINCINNATI OH
45243-2608
US

IV. Provider business mailing address

PO BOX 637676
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 513-561-6266
  • Fax: 513-561-0149
Mailing address:
  • Phone: 513-561-6266
  • Fax: 513-561-0149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-08-7708
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35.087708
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: