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NPI Code Detail

MEDICARE: GLADYS A. BEALE M.D.

MEDICARE: GLADYS A. BEALE M.D.
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
12084P0804XChild & Adolescent Psychiatry Physician01052426AIN
22084F0202XForensic Psychiatry Physician01052426AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4260043528OTHERRAILROAD MEDICARE
5P00466953OTHERINRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000543920OTHERINANTHEM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164401063
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLADYS A. BEALE M.D.
Provider Business Mailing Address
First Line : 11109 PARKVIEW PLAZA DR # 117
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1701
Country : US
Telephone Number : 260-266-6013
Fax Number :
Provider Business Practice Location Address
First Line : 1720 BEACON ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-4749
Country : US
Telephone Number : 260-373-8000
Fax Number : 260-373-8034
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2006
Last Update Date : 10/11/2022

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Directions to “ GLADYS A. BEALE M.D.” Practice Location

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