Basic Information
| Provider Information | |||||||||
| NPI: | 1831155324 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEAN | ||||||||
| FirstName: | CHRISTIAN | ||||||||
| MiddleName: | H.G. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 FISHER RD | ||||||||
| Address2: | BUILDING A, SUITE 2-2 | ||||||||
| City: | BERLIN | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056029516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022292663 | ||||||||
| FaxNumber: | 8022296645 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 FISHER RD | ||||||||
| Address2: | BUILDING A, SUITE 2-2 | ||||||||
| City: | BERLIN | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056029516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022292663 | ||||||||
| FaxNumber: | 8022296645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2006 | ||||||||
| LastUpdateDate: | 10/21/2011 | ||||||||
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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 | 207X00000X | 0420009121 | VT | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 30207742 | 05 | NH | MEDICAID | 0VN1185 | 05 | VT | MEDICAID | P00016937 | 01 | VT | RAIL ROAD MEDICARE | OTHER |