Provider Demographics
NPI:1457889834
Name:BEEN, CHRISTIAN ROBERTS (CP, BOCO)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ROBERTS
Last Name:BEEN
Suffix:
Gender:M
Credentials:CP, BOCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 EMPIRE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6710
Mailing Address - Country:US
Mailing Address - Phone:336-397-2165
Mailing Address - Fax:336-397-2167
Practice Address - Street 1:1103 N ELM ST STE 201
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401
Practice Address - Country:US
Practice Address - Phone:336-478-9400
Practice Address - Fax:336-478-9404
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C51530222Z00000X
CP03333224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP03333OtherAMERICAN BOARD OF CERTIFICATION
PAPO000074OtherSTATE LICENSE
C51530OtherTHE BOARD OF CERTIFICATION / ACCREDITATION, INTERNATIONAL