1710980412 NPI number — ANTOINETTE ALONZO BEAMAN MD

Table of content: ANTOINETTE ALONZO BEAMAN MD (NPI 1710980412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710980412 NPI number — ANTOINETTE ALONZO BEAMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEAMAN
Provider First Name:
ANTOINETTE
Provider Middle Name:
ALONZO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALONZO-BEAMAN
Provider Other First Name:
ANTOINETTE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710980412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
806 HURON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIBSONIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15044-8039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-352-9261
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8000 CRANBERRY SPRINGS DR FL 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANBERRY TWP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16066-6687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-720-3098
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD425932 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1012714210002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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