Provider Demographics
NPI:1427251263
Name:BEATTY, CHARLES LEO III (DPM)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LEO
Last Name:BEATTY
Suffix:III
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:7650 BROADVIEW ROAD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134
Mailing Address - Country:US
Mailing Address - Phone:216-524-1632
Mailing Address - Fax:216-524-1632
Practice Address - Street 1:7441 WEST RIDGEWOOD DRIVE
Practice Address - Street 2:PARMATOWN MEDICAL BLDG NORTH #253
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5544
Practice Address - Country:US
Practice Address - Phone:216-524-1632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH1790213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist