Provider Demographics
NPI:1861600595
Name:BEAN, CYNTHIA (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:BEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 DRAPERTON DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-3907
Mailing Address - Country:US
Mailing Address - Phone:601-973-7405
Mailing Address - Fax:601-973-7406
Practice Address - Street 1:214 DRAPERTON DR
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-3907
Practice Address - Country:US
Practice Address - Phone:601-973-7405
Practice Address - Fax:601-973-7406
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21041207V00000X, 207VM0101X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00026087Medicaid
MS302I163576Medicare UPIN
MS00026087Medicaid