Provider Demographics
NPI:1235246737
Name:BEARDSLEY, JOSEPH A (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:BEARDSLEY
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 1:1777 W STONES CROSSING RD
Mailing Address - Street 2:STE 1
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7899
Mailing Address - Country:US
Mailing Address - Phone:317-346-5480
Mailing Address - Fax:
Practice Address - Street 1:1777 W STONES CROSSING RD
Practice Address - Street 2:STE 1
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-7899
Practice Address - Country:US
Practice Address - Phone:317-346-5480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031707A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN239532OtherANTHEM
193530Medicare PIN
IN239532OtherANTHEM