MEDICARE: DR. MIRIAM E BEADLE PH.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	103G00000X	Clinical Neuropsychologist	PSY1000047	DC

General Provider Information

NPI Number	:	1669445821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIRIAM E BEADLE PH.D

Provider Business Mailing Address
First Line	:	PO BOX 638
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-0638
Country	:	US
Telephone Number	:	202-536-5602
Fax Number	:	202-263-1168

Provider Business Practice Location Address
First Line	:	3000 CONNECTICUT AVE NW
Second Line	:	SUITE #136
City	:	WASHINGTON
State	:	DC
Zip	:	20008-2509
Country	:	US
Telephone Number	:	202-536-5602
Fax Number	:	202-263-1168

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	02/19/2008

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