Provider Demographics
NPI:1801203476
Name:BEAMER, BRADEN (BS)
Entity Type:Individual
Prefix:
First Name:BRADEN
Middle Name:
Last Name:BEAMER
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 BOWMAN ST
Mailing Address - Street 2:UNIT #1
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-5448
Mailing Address - Country:US
Mailing Address - Phone:570-823-5808
Mailing Address - Fax:570-970-2725
Practice Address - Street 1:330 BOWMAN ST
Practice Address - Street 2:UNIT 1
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-5448
Practice Address - Country:US
Practice Address - Phone:570-823-5808
Practice Address - Fax:570-970-2725
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management