Provider Demographics
NPI:1831155324
Name:BEAN, CHRISTIAN HG (MD)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:HG
Last Name:BEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 FISHER RD
Mailing Address - Street 2:BUILDING A, SUITE 2-2
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-9516
Mailing Address - Country:US
Mailing Address - Phone:802-229-2663
Mailing Address - Fax:802-229-6645
Practice Address - Street 1:130 FISHER RD
Practice Address - Street 2:BUILDING A, SUITE 2-2
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9516
Practice Address - Country:US
Practice Address - Phone:802-229-2663
Practice Address - Fax:802-229-6645
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420009121207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30207742Medicaid
VT0VN1185Medicaid
VTP00016937OtherRAIL ROAD MEDICARE
VTNX2005Medicare PIN
VTP00016937OtherRAIL ROAD MEDICARE
VTVN1185Medicare PIN