Healthcare Provider Details

I. General information

NPI: 1730159351
Provider Name (Legal Business Name): BETH SIMONOWITZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 10/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 JOHN YOUNG WAY SUITE 201 MAIN LINE HEALTH CENTER
EXTON PA
19341-2567
US

IV. Provider business mailing address

491 JOHN YOUNG WAY SUITE 201 MAIN LINE HEALTH CENTER
EXTON PA
19341-2567
US

V. Phone/Fax

Practice location:
  • Phone: 484-565-8507
  • Fax: 610-280-1531
Mailing address:
  • Phone: 484-565-8507
  • Fax: 610-280-1531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD026288E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001613900
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier232359401
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMAIN LINE HEALTHCARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: