MEDICARE: DR. DEBORAH A BEITER MD

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	207Q00000X	Family Medicine Physician	25MA04079700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609876648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH A BEITER MD

Provider Business Mailing Address
First Line	:	PO BOX 459 130 RIVERFRONT TERRACE
Second Line	:
City	:	POCONO LAKE
State	:	PA
Zip	:	18347
Country	:	US
Telephone Number	:	570-643-5020
Fax Number	:	570-643-5020

Provider Business Practice Location Address
First Line	:	130 RIVERFRONT TERRACE
Second Line	:
City	:	POCONO LAKE
State	:	PA
Zip	:	18347-2519
Country	:	US
Telephone Number	:	570-643-5020
Fax Number	:	570-643-5020

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	07/21/2022

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