Healthcare Provider Details

I. General information

NPI: 1235126715
Provider Name (Legal Business Name): MARTIN F BETTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 GLENSIDE DR SUITE 103
RICHMOND VA
23226-3769
US

IV. Provider business mailing address

PO BOX 8266
RICHMOND VA
23226-0266
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-0100
  • Fax: 804-285-2458
Mailing address:
  • Phone: 804-285-0100
  • Fax: 804-285-2458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101029467
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: