Provider Demographics
NPI:1710630256
Name:BEAM, ALEXANDER WILLIAM
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:WILLIAM
Last Name:BEAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12500 WILLOWBROOK RD FL 1
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6393
Mailing Address - Country:US
Mailing Address - Phone:240-964-1055
Mailing Address - Fax:240-964-1136
Practice Address - Street 1:12500 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6393
Practice Address - Country:US
Practice Address - Phone:240-964-1055
Practice Address - Fax:240-964-1133
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00257-20-A172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No172V00000XOther Service ProvidersCommunity Health Worker