Healthcare Provider Details

I. General information

NPI: 1720272818
Provider Name (Legal Business Name): MAGGIE BEAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 WALNUT ST APT 1003
PHILADELPHIA PA
19107-5446
US

IV. Provider business mailing address

1218 WALNUT ST APT 1003
PHILADELPHIA PA
19107-5446
US

V. Phone/Fax

Practice location:
  • Phone: 518-461-6633
  • Fax:
Mailing address:
  • Phone: 518-461-6633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberMT186449
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: