Basic Information
| Provider Information | |||||||||
| NPI: | 1609823145 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEAN | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 783311 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191783311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4848844500 | ||||||||
| FaxNumber: | 4848840699 | ||||||||
| Practice Location | |||||||||
| Address1: | 1337 BLUE VALLEY DR | ||||||||
| Address2: | SUITE 8 | ||||||||
| City: | PEN ARGYL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180721815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106541230 | ||||||||
| FaxNumber: | 6106541232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 03/01/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | OS011226 | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00087133 | 01 | PA | RR MEDICARE | OTHER | 0019598250003 | 05 | PA | MEDICAID | BE927846 | 01 | PA | BLUE SHIELD | OTHER |