Provider Demographics
NPI:1992273890
Name:SANDPIPERMD, INC.
Entity type:Organization
Organization Name:SANDPIPERMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-242-0420
Mailing Address - Street 1:6 E WILLOW GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3426
Mailing Address - Country:US
Mailing Address - Phone:215-242-0420
Mailing Address - Fax:215-764-6447
Practice Address - Street 1:6 E WILLOW GROVE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-3426
Practice Address - Country:US
Practice Address - Phone:215-242-0420
Practice Address - Fax:215-764-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty