Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2011-00061 | NC |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 35091757 | OH |
NPI | 1659588267 |
---|---|
Provider Name | Matthew Craig Beran |
First Address | Columbus, OH 43205-2664 |
Second Address | Columbus, OH 43205-2664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 18/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5917454 | (05) | NC |
NC1375 | (05) | SC |