Provider Demographics
NPI:1679759781
Name:BEAM, CYNTHIA L (PA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:BEAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 MORREENE RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4410
Mailing Address - Country:US
Mailing Address - Phone:919-668-2879
Mailing Address - Fax:919-668-2855
Practice Address - Street 1:1785 BALDHEAD ISLAND DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-8576
Practice Address - Country:US
Practice Address - Phone:576-212-2627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04386363A00000X
VA0110002539363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1679759781Medicaid