Provider Demographics
NPI:1437115839
Name:BEAM, BRIAN B (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:B
Last Name:BEAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2204
Mailing Address - Country:US
Mailing Address - Phone:330-287-4500
Mailing Address - Fax:
Practice Address - Street 1:1740 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2204
Practice Address - Country:US
Practice Address - Phone:330-287-4500
Practice Address - Fax:330-264-6607
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057382207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00082587OtherMEDICARE RAILROAD
OH0709291Medicaid
OHA58415Medicare UPIN
OH0709291Medicaid