Provider Demographics
NPI:1699737643
Name:ARCHER, BETH ALYSON (MD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:ALYSON
Last Name:ARCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-5600
Mailing Address - Fax:704-316-5613
Practice Address - Street 1:9930 KINCEY AVE STE 300
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6541
Practice Address - Country:US
Practice Address - Phone:704-316-5600
Practice Address - Fax:704-316-5613
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9500976207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN00977Medicaid
NC5900439Medicaid
NC2217316CMedicare PIN
SCN00977Medicaid