Healthcare Provider Details

I. General information

NPI: 1063531119
Provider Name (Legal Business Name): ADRIENNE BEAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E MOREHEAD ST STE 300
CHARLOTTE NC
28202-2788
US

IV. Provider business mailing address

700 E MOREHEAD ST STE 300
CHARLOTTE NC
28202-2788
US

V. Phone/Fax

Practice location:
  • Phone: 704-334-7800
  • Fax: 704-414-7512
Mailing address:
  • Phone: 704-334-7800
  • Fax: 704-414-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number2011-00963
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number35098
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35098
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2011-00963
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: