Provider Demographics
NPI:1093713117
Name:BEAMAN, CARLTON REID JR (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLTON
Middle Name:REID
Last Name:BEAMAN
Suffix:JR
Gender:M
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 1:130 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-4946
Mailing Address - Country:US
Mailing Address - Phone:252-308-0686
Mailing Address - Fax:252-308-0872
Practice Address - Street 1:130 CARDINAL DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4946
Practice Address - Country:US
Practice Address - Phone:252-308-0686
Practice Address - Fax:252-308-0872
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000101911363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2799481FMedicare ID - Type Unspecified
NCS24997Medicare UPIN