Provider Demographics
NPI:1972571057
Name:BEYNEN, AGATHA SOPHIA (MD)
Entity type:Individual
Prefix:
First Name:AGATHA
Middle Name:SOPHIA
Last Name:BEYNEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6870 PERIMETER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8047
Mailing Address - Country:US
Mailing Address - Phone:614-777-9804
Mailing Address - Fax:614-777-9806
Practice Address - Street 1:6870 PERIMETER DR
Practice Address - Street 2:SUITE B
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8047
Practice Address - Country:US
Practice Address - Phone:614-777-9804
Practice Address - Fax:614-777-9806
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-5015207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2150443Medicaid
OHG97865Medicare UPIN
OHBE7261141Medicare ID - Type Unspecified