Provider Demographics
NPI:1477821429
Name:BEAM, CHARLES REAGAN (HIS)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:REAGAN
Last Name:BEAM
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13801 REESE BLVD W
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6308
Mailing Address - Country:US
Mailing Address - Phone:704-992-6130
Mailing Address - Fax:704-992-6140
Practice Address - Street 1:13801 REESE BLVD W
Practice Address - Street 2:SUITE 210
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6308
Practice Address - Country:US
Practice Address - Phone:704-992-6130
Practice Address - Fax:704-992-6140
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1259237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist