MEDICARE: DR. JONATHAN A. BEATTY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME162732	FL
2	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	MD441308	PA
3	2084P0800X	Psychiatry Physician	MD441308	PA

General Provider Information

NPI Number	:	1205028149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN A. BEATTY M.D.

Provider Business Mailing Address
First Line	:	6 E WILLOW GROVE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-3426
Country	:	US
Telephone Number	:	215-242-0420
Fax Number	:	215-764-6447

Provider Business Practice Location Address
First Line	:	6 E WILLOW GROVE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-3426
Country	:	US
Telephone Number	:	215-242-0420
Fax Number	:	215-764-6447

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	12/01/2024

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