Healthcare Provider Details

I. General information

NPI: 1346334893
Provider Name (Legal Business Name): BETH L BITTINGER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 ORRS LN
TRIADELPHIA WV
26059-1455
US

IV. Provider business mailing address

1385 STONE CHURCH RD
WHEELING WV
26003-7464
US

V. Phone/Fax

Practice location:
  • Phone: 304-547-9197
  • Fax: 304-547-9198
Mailing address:
  • Phone: 304-233-0505
  • Fax: 304-233-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number1105
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number01105
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: