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General NPI Number Information
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NPI Number | 1518463009
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Entity Type | Individual
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Provider Name | MATTHEW RYAN BEAMER MD
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Gender | Male
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 2660 MAIN ST STE 117
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City | BRIDGEPORT
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State | CT
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Zip | 06606-5301
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Country | US
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Telephone | 203-338-8760
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Fax | 203-338-8765
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Provider Business Mailing Address
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Address Line | 1290 SILAS DEANE HWY
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City | WETHERSFIELD
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State | CT
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Zip | 06109-4337
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 73685
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License Number State | CT
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