Provider Demographics
NPI:1144640202
Name:BEAMS, MARJORIE EDEN (MD)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:EDEN
Last Name:BEAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:EDEN
Other - Last Name:CHILDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 CAMPUS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5892
Mailing Address - Country:US
Mailing Address - Phone:603-422-8208
Mailing Address - Fax:
Practice Address - Street 1:100 CAMPUS DR STE 100
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5892
Practice Address - Country:US
Practice Address - Phone:603-422-8208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2018-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NH19113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program