Basic Information
| Provider Information | |||||||||
| NPI: | 1104828979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEALS | ||||||||
| FirstName: | BRIAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 133 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035702006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037522040 | ||||||||
| FaxNumber: | 6037521709 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 BROADWAY AVE | ||||||||
| Address2: | |||||||||
| City: | GORHAM | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035811502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034662741 | ||||||||
| FaxNumber: | 6034662953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 09/15/2017 | ||||||||
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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 | 208000000X | 9177 | NH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 784908 | 01 | NH | MVP HEALTHCARE | OTHER | RE7915 | 01 | MEDICARE NUMBER | OTHER | 0109720YPNH02 | 01 | NH | ANTHEM BC/BS | OTHER | 30007014 | 05 | NH | MEDICAID | 5756404001 | 01 | NH | CIGNA HEALTHCARE | OTHER | 5830418 | 01 | AETNA GROUP | OTHER | 3072544 | 05 | NH | MEDICAID | 9177 | 01 | NH | STATE LICENSE # | OTHER |