=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124022645
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETH ANNE BERRETTONI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2005
-----------------------------------------------------
Last Update Date | 11/14/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2350 MIAMI VALLEY DR STE 310
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-4778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-435-4263
-----------------------------------------------------
Fax | 937-298-9459
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2350 MIAMI VALLEY DR STE 310
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-4778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-435-4263
-----------------------------------------------------
Fax | 937-298-9459
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0106X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Hand Surgery Physician
-----------------------------------------------------
License Number | 35054146
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------