MEDICARE: DR. BETTY ANN KYSER 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	208000000X	Pediatrics Physician	D0040080	MD

General Provider Information

NPI Number	:	1679740120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETTY ANN KYSER MD

Provider Business Mailing Address
First Line	:	3054 GREENHAVEN CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042
Country	:	US
Telephone Number	:	410-465-1585
Fax Number	:

Provider Business Practice Location Address
First Line	:	3054 GREENHAVEN CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7828
Country	:	US
Telephone Number	:	410-465-1585
Fax Number	:

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

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	01/10/2013

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