Provider Demographics
NPI:1568442432
Name:BINGAMAN, BETH ANN (DO)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:BINGAMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1161 MCDERMOTT DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4064
Mailing Address - Country:US
Mailing Address - Phone:610-701-7011
Mailing Address - Fax:610-429-5199
Practice Address - Street 1:1161 MCDERMOTT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4064
Practice Address - Country:US
Practice Address - Phone:610-701-7011
Practice Address - Fax:610-429-5199
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS008420L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA23-2359401OtherMLHC TAX ID
G30372Medicare UPIN
PA0015953560003Medicaid
G30372Medicare UPIN