Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 35.139816 | OH |
Y | 2084N0402X | Child Neurologist | 35.139816 | OH |
NPI | 1174765648 |
---|---|
Provider Name | Christopher William Beatty |
First Address | Seattle, WA 98105-3901 |
Second Address | Columbus, OH 43205-2664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2009 |
Last Update Date | 11/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0411208 | (05) | OH |
1174765648 | (05) | WA |
H791330 | CGS - MEDICARE (01) | OH |