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NPI Code Detail

MEDICARE: CARLTON REID BEAMAN JR. PA-C

MEDICARE: CARLTON REID BEAMAN JR. PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant000101911NC

General Provider Information

NPI Number : 1093713117
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLTON REID BEAMAN JR. PA-C
Provider Business Mailing Address
First Line : 130 CARDINAL DR
Second Line :
City : ROANOKE RAPIDS
State : NC
Zip : 27870-4946
Country : US
Telephone Number : 252-308-0686
Fax Number : 252-308-0872
Provider Business Practice Location Address
First Line : 130 CARDINAL DR
Second Line :
City : ROANOKE RAPIDS
State : NC
Zip : 27870-4946
Country : US
Telephone Number : 252-308-0686
Fax Number : 252-308-0872
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 11/15/2018

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