Provider Demographics
NPI:1073524302
Name:BEARD, JONATHAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:D
Last Name:BEARD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2085 HURONTARIO STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MISSISSAUGA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L5A 4G1
Mailing Address - Country:CA
Mailing Address - Phone:905-848-7484
Mailing Address - Fax:905-804-7912
Practice Address - Street 1:2085 HURONTARIO STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:MISSISSAUGA
Practice Address - State:ONTARIO
Practice Address - Zip Code:L5A 4G1
Practice Address - Country:CA
Practice Address - Phone:905-848-7484
Practice Address - Fax:905-804-7912
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2010-06-03
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Provider Licenses
StateLicense IDTaxonomies
NY2439162084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02932718Medicaid
NYRB6816Medicare PIN
NYRB6815Medicare PIN