Basic Information
| Provider Information | |||||||||
| NPI: | 1275093809 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEAN | ||||||||
| FirstName: | MARTA | ||||||||
| MiddleName: | BRYGIDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 SHIRLEY RD | ||||||||
| Address2: | |||||||||
| City: | NARBERTH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190722015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102919740 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3400 SPRUCE ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191044238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007897366 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2019 | ||||||||
| LastUpdateDate: | 09/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.