Provider Demographics
NPI:1972783173
Name:MAGDALENA BELTRE MD PA
Entity type:Organization
Organization Name:MAGDALENA BELTRE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAGDALENA
Authorized Official - Middle Name:GUILLERMINA
Authorized Official - Last Name:BELTRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-339-2910
Mailing Address - Street 1:106 BOSTON AVE
Mailing Address - Street 2:206
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4731
Mailing Address - Country:US
Mailing Address - Phone:407-339-2910
Mailing Address - Fax:407-830-7801
Practice Address - Street 1:106 BOSTON AVENUE
Practice Address - Street 2:206
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7854
Practice Address - Country:US
Practice Address - Phone:407-339-2910
Practice Address - Fax:407-830-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73367207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252739100Medicaid
FL252739100Medicaid
FLG63305Medicare UPIN