Basic Information
| Provider Information | |||||||||
| NPI: | 1134685399 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAITS | ||||||||
| FirstName: | BETHANY | ||||||||
| MiddleName: | LYNNE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RD, LDN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 100 S JACKSON AVE FL 3 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152023428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123598951 | ||||||||
| FaxNumber: | 4127347795 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 S JACKSON AVE FL 3 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152023428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123598951 | ||||||||
| FaxNumber: | 4127347795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2019 | ||||||||
| LastUpdateDate: | 10/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DN006663 | PA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 14418350 | 01 | CAQH | OTHER | 103606489 | 05 | PA | MEDICAID |