Provider Demographics
NPI:1609823145
Name:BEAN, ERIC WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WILLIAM
Last Name:BEAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:1337 BLUE VALLEY DR
Practice Address - Street 2:SUITE 8
Practice Address - City:PEN ARGYL
Practice Address - State:PA
Practice Address - Zip Code:18072-1815
Practice Address - Country:US
Practice Address - Phone:610-654-1230
Practice Address - Fax:610-654-1232
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011226207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00087133OtherRR MEDICARE
PA0019598250003Medicaid
PABE927846OtherBLUE SHIELD
PAP00087133OtherRR MEDICARE
PA0019598250003Medicaid