Provider Demographics
NPI:1811485725
Name:BEANUM, RICHARD MCKINLEY SR
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MCKINLEY
Last Name:BEANUM
Suffix:SR
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 1:56 CYNTHIAS PL APT 302
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-7436
Mailing Address - Country:US
Mailing Address - Phone:540-898-0787
Mailing Address - Fax:
Practice Address - Street 1:56 CYNTHIAS PL APT 302
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-7436
Practice Address - Country:US
Practice Address - Phone:540-898-0787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT67317368347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle