Healthcare Provider Details

I. General information

NPI: 1942445929
Provider Name (Legal Business Name): HERBERT BEAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 PATTON RD
DEVENS MA
01434-3802
US

IV. Provider business mailing address

42 PATTON RD
DEVENS MA
01434-3802
US

V. Phone/Fax

Practice location:
  • Phone: 978-796-1000
  • Fax: 978-796-1537
Mailing address:
  • Phone: 978-796-1000
  • Fax: 978-796-1537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9303
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00017448
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: