Healthcare Provider Details

I. General information

NPI: 1215124599
Provider Name (Legal Business Name): WILLIAM EDWARD BEATIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E ALLEGHENY AVE DEPT. OF ORTHOPEDIC & SPORTS MEDICINE
PHILADELPHIA PA
19134-4427
US

IV. Provider business mailing address

3425 N CARLISLE ST 2ND FLOOR HUDSON BUILDING
PHILADELPHIA PA
19140-5108
US

V. Phone/Fax

Practice location:
  • Phone: 215-291-3777
  • Fax: 215-291-3776
Mailing address:
  • Phone: 215-707-8561
  • Fax: 215-707-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD41048
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: