Provider Demographics
NPI:1255386066
Name:BEAN, JEFFREY J (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:BEAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 MACKWORTH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-4534
Mailing Address - Country:US
Mailing Address - Phone:207-415-1910
Mailing Address - Fax:
Practice Address - Street 1:335 BRIGHTON AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2362
Practice Address - Country:US
Practice Address - Phone:207-662-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2037207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME4991097OtherCIGNA
ME432826999Medicaid
OH00236042OtherMEDICARE RAILROAD
ME7209651OtherAETNA
MEAA109573OtherHARVARD PILGRIM
ME200882OtherANTHEM
ME200882OtherANTHEM
ME000439301Medicare PIN