MEDICARE: DR. ETHAN BEAN 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
1	2084P0800X	Psychiatry Physician	2015-00236	NC

General Provider Information

NPI Number	:	1477544021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ETHAN BEAN M.D.

Provider Business Mailing Address
First Line	:	3040 HAMMOND BUSINESS PL
Second Line	:	SUITE 105
City	:	RALEIGH
State	:	NC
Zip	:	27603-3666
Country	:	US
Telephone Number	:	919-899-6259
Fax Number	:	919-838-9074

Provider Business Practice Location Address
First Line	:	3040 HAMMOND BUSINESS PL
Second Line	:	SUITE 105
City	:	RALEIGH
State	:	NC
Zip	:	27603-3666
Country	:	US
Telephone Number	:	919-899-6259
Fax Number	:	919-838-9074

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	08/21/2015

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