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General NPI Number Information
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NPI Number | 1730390873
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Entity Type | Individual
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Provider Name | CHARLES MERRITT BEASLEY JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8161 BEECH KNLS
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-2107
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Country | US
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Telephone | 317-578-2714
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Fax | 317-578-2801
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Provider Business Mailing Address
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Address Line | 8161 BEECH KNLS
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-2107
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Country | US
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Telephone | 317-578-2714
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Fax | 317-578-2801
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 01045668A
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License Number State | IN
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