Provider Demographics
NPI:1760434120
Name:BEAN, HOWARD CARLISLE (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:CARLISLE
Last Name:BEAN
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:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:1690 SKYLYN DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1072
Practice Address - Country:US
Practice Address - Phone:864-253-8170
Practice Address - Fax:864-585-7787
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00386784OtherMEDICARE RAILROAD PTAN #
SCSCE4895019OtherMEDICARE PIN
SCSCE4896084OtherMEDICARE PIN
SC088826Medicaid
SC5878670019Medicare NSC