Healthcare Provider Details

I. General information

NPI: 1568434710
Provider Name (Legal Business Name): DAVID R BEATTY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 JEFFERSON ST N
LEWISBURG WV
24901-1380
US

IV. Provider business mailing address

1464 JEFFERSON ST N
LEWISBURG WV
24901-1380
US

V. Phone/Fax

Practice location:
  • Phone: 304-645-3220
  • Fax: 304-645-4103
Mailing address:
  • Phone: 304-645-3220
  • Fax: 844-479-4545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number1577
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: