Doctor Name: | DR. CHARLES A BEVAN |
NPI Number: | 1164600904 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 01065537A |
Business Practice Address: | 300 Main St Dept Of Emergency Medicine Lewiston, ME - 042407027 |
Business Phone Number: | 8033615589 |
Business Fax Number: | |
Mailing Address: | 300 Main St, Dept Of Emergency Medicine LEWISTON |
State: | ME |
Postal Code: | 042407027 |
Phone Number: | 8033615589 |
Fax Number: | |
NPI Enumeration Date: | 02/04/2008 |
NPI Last Update Date: | 06/25/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 01065537A |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |