Provider Demographics
NPI:1730159351
Name:SIMONOWITZ, BETH (MD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:
Last Name:SIMONOWITZ
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 1:491 JOHN YOUNG WAY
Mailing Address - Street 2:SUITE 201 MAIN LINE HEALTH CENTER
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2567
Mailing Address - Country:US
Mailing Address - Phone:484-565-8507
Mailing Address - Fax:610-280-1531
Practice Address - Street 1:491 JOHN YOUNG WAY
Practice Address - Street 2:SUITE 201 MAIN LINE HEALTH CENTER
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2567
Practice Address - Country:US
Practice Address - Phone:484-565-8507
Practice Address - Fax:610-280-1531
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2011-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026288E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001613900Medicaid
PA232359401OtherMAIN LINE HEALTHCARE
PA232359401OtherMAIN LINE HEALTHCARE
PA189350HK1Medicare PIN