Provider Demographics
NPI:1386704971
Name:BEALE, ESTELA A (MD)
Entity type:Individual
Prefix:
First Name:ESTELA
Middle Name:A
Last Name:BEALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ESTELA
Other - Middle Name:MARTA
Other - Last Name:AGUIRRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4900 WYALUSING AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-5127
Mailing Address - Country:US
Mailing Address - Phone:215-921-3713
Mailing Address - Fax:
Practice Address - Street 1:4900 WYALUSING AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-5127
Practice Address - Country:US
Practice Address - Phone:215-473-7033
Practice Address - Fax:215-878-9199
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS141422084P0800X
CO241412084P0800X
OK105312084P0800X
TXH71222084P0800X
PAMD4480672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123161501Medicaid
82M344Medicare ID - Type UnspecifiedMDACC MEDICARE