Provider Demographics
NPI:1730160953
Name:BEAN, JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:BEAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-952-6800
Mailing Address - Fax:617-573-2759
Practice Address - Street 1:300 1ST AVE
Practice Address - Street 2:SRH SPAULDING REHAB HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02129-3109
Practice Address - Country:US
Practice Address - Phone:617-952-6800
Practice Address - Fax:617-573-2727
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2016-08-22
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Provider Licenses
StateLicense IDTaxonomies
MA77970208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA077970OtherTUFTS HEALTH PLAN
MAJ14109OtherBCBS MA
MA3112730Medicaid
MA3112730Medicaid
MA077970OtherTUFTS HEALTH PLAN