Provider Demographics
NPI:1669445821
Name:BEADLE, MIRIAM E (PHD)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:E
Last Name:BEADLE
Suffix:
Gender:F
Credentials:PHD
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 638
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-0638
Mailing Address - Country:US
Mailing Address - Phone:202-536-5602
Mailing Address - Fax:202-263-1168
Practice Address - Street 1:3000 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE #136
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2509
Practice Address - Country:US
Practice Address - Phone:202-536-5602
Practice Address - Fax:202-263-1168
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000047103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC492069Medicare ID - Type Unspecified
DCP65263Medicare UPIN