Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | SC006379 | PA |
NPI | 1073878971 |
---|---|
Provider Name | Dr. Thomas Charles Beideman |
First Address | Harrisburg, PA 17112-2607 |
Second Address | Harrisburg, PA 17112-2607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2012 |
Last Update Date | 20/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1030765150 | (05) | PA |