Provider Demographics
NPI:1427074699
Name:BEATTY, DENNIS R (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:R
Last Name:BEATTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 DOREY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-8108
Mailing Address - Country:US
Mailing Address - Phone:802-862-9627
Mailing Address - Fax:
Practice Address - Street 1:1 TIMBER LN
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7205
Practice Address - Country:US
Practice Address - Phone:802-847-4714
Practice Address - Fax:802-847-6333
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0010372207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008663Medicaid
NYEO2271896Medicaid
NYEO2271896Medicaid
VN2902Medicare ID - Type Unspecified