Healthcare Provider Details

I. General information

NPI: 1679759781
Provider Name (Legal Business Name): CYNTHIA L BEAM P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1785 BALDHEAD ISLAND DR
APEX NC
27502-8576
US

IV. Provider business mailing address

932 MORREENE RD
DURHAM NC
27705-4410
US

V. Phone/Fax

Practice location:
  • Phone: 576-212-2627
  • Fax:
Mailing address:
  • Phone: 919-668-2879
  • Fax: 919-668-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-04386
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110002539
License Number StateVA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1679759781
Identifier TypeMEDICAID
Identifier StateVA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: