Provider Demographics
NPI:1730534819
Name:BEAHM, TREVOR SCOTT
Entity type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:SCOTT
Last Name:BEAHM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 CANDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-1248
Mailing Address - Country:US
Mailing Address - Phone:814-404-8967
Mailing Address - Fax:
Practice Address - Street 1:406 CANDLEWOOD DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-1248
Practice Address - Country:US
Practice Address - Phone:814-404-8967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA30596330390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program