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General NPI Number Information
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NPI Number | 1598250912
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Entity Type | Individual
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Provider Name | ELODIE MARIE BETANCES MD
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Gender | Female
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 3333 BURNETT AVE ML 4002
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City | CINCINNATI
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State | OH
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Zip | 45229
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Country | US
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Telephone | 718-579-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 3333 BURNET AVE ML 4002
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City | CINCINNATI
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State | OH
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Zip | 45229
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Country | US
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Telephone | 718-219-5472
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number | 35.141668
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License Number State | OH
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