Provider Demographics
NPI:1336356021
Name:BEAVER, ANDREW B (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:B
Last Name:BEAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 408
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-968-3670
Mailing Address - Fax:856-968-8588
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 408
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-968-3670
Practice Address - Fax:856-968-8588
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430687207X00000X
NJMA08983100207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA08983100OtherSTATE LICENSE