Provider Demographics
NPI:1447354410
Name:BETTERIDGE, JOHN D (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:BETTERIDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 HARRISBURG PIKE STE 202
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-869-4600
Mailing Address - Fax:717-544-3501
Practice Address - Street 1:2112 HARRISBURG PIKE
Practice Address - Street 2:SUITE 202
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-3500
Practice Address - Fax:717-544-3501
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD453962207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP1818459OtherRR MEDICARE
PA1029978880003Medicaid
PAP01818459OtherRR MEDICARE
PA1029978880001Medicaid
PA400347KKUOtherMEDICARE
PA1029978880002Medicaid
PAMD453962OtherMEDICAL LICENSE