Provider Demographics
NPI:1528263357
Name:PILLA, BETH (MED)
Entity type:Individual
Prefix:MISS
First Name:BETH
Middle Name:
Last Name:PILLA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 HUXLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-2856
Mailing Address - Country:US
Mailing Address - Phone:401-274-1033
Mailing Address - Fax:
Practice Address - Street 1:63 HUXLEY AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-2856
Practice Address - Country:US
Practice Address - Phone:401-274-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA359847235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA359847Medicare UPIN