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General NPI Number Information
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NPI Number | 1811485725
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Entity Type | Individual
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Provider Name | MR. RICHARD MCKINLEY BEANUM SR.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2018
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 56 CYNTHIAS PL APT 302
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City | FREDERICKSBURG
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State | VA
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Zip | 22406-7436
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Country | US
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Telephone | 540-898-0787
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Fax |
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Provider Business Mailing Address
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Address Line | 56 CYNTHIAS PL APT 302
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City | FREDERICKSBURG
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State | VA
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Zip | 22406-7436
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Country | US
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Telephone | 540-898-0787
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | T67317368
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License Number State | VA
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