Healthcare Provider Details

I. General information

NPI: 1124126354
Provider Name (Legal Business Name): STEVEN M BEAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 INGALLS CT
METHUEN MA
01844-3712
US

IV. Provider business mailing address

37 FRIEND ST
LYNN MA
01902-3068
US

V. Phone/Fax

Practice location:
  • Phone: 978-722-0175
  • Fax: 781-268-5070
Mailing address:
  • Phone: 781-715-6608
  • Fax: 781-268-5070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42646
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: