Provider Demographics
NPI:1720260110
Name:BRUCE E. BEACHAM, M.D., P.A.
Entity Type:Organization
Organization Name:BRUCE E. BEACHAM, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-583-2328
Mailing Address - Street 1:1205 YORK RD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6210
Mailing Address - Country:US
Mailing Address - Phone:410-583-2328
Mailing Address - Fax:410-583-2479
Practice Address - Street 1:1205 YORK RD
Practice Address - Street 2:SUITE 20
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6210
Practice Address - Country:US
Practice Address - Phone:410-583-2328
Practice Address - Fax:410-583-2479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019901207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD010246OtherEHP
MDG847/0001OtherBLUECHOICE/FEDERAL BS
MD3204645OtherAETNA HMO
MDKEI3/30272004OtherBC/BS
MD193582OtherCOVENTRY
MD4067476OtherAETNA PPO
MD4067476OtherAETNA PPO
MD=========OtherCIGNA
MDG847/0001OtherBLUECHOICE/FEDERAL BS