Provider Demographics
NPI:1073508826
Name:BEAMS, ANGELA (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BEAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S MAIN RD
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-7897
Mailing Address - Country:US
Mailing Address - Phone:856-692-0502
Mailing Address - Fax:856-691-1710
Practice Address - Street 1:301 S MAIN RD
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7897
Practice Address - Country:US
Practice Address - Phone:856-692-0502
Practice Address - Fax:856-691-1710
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00529200363AM0700X
FLPA3146363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL970022448OtherMEDICARE RR
FLP01464Medicare UPIN
FLE3777WMedicare PIN