Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 01067761 | IN |
Y | 2080P0203X | Pediatric Critical Care Doctor | 01067761 | IN |
NPI | 1093976615 |
---|---|
Provider Name | Dr. Andrew Lee Beardsley |
First Address | Indianapolis, IN 46206-1026 |
Second Address | Indianapolis, IN 46202-5109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2008 |
Last Update Date | 03/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201005490 | (05) | IN |
P01824403 | RR MEDICARE (01) | IN |