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General NPI Number Information
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NPI Number | 1336730654
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Entity Type | Individual
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Provider Name | PETER WOLFGANG LEDWIN BEAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/29/2021
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 27 GAMECOCK AVE STE 201
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City | CHARLESTON
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State | SC
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Zip | 29407-3398
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Country | US
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Telephone | 843-769-8215
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Fax |
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Provider Business Mailing Address
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Address Line | 27 GAMECOCK AVE STE 201
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City | CHARLESTON
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State | SC
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Zip | 29407-3398
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-12167
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5118
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License Number State | SC
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