Provider Demographics
NPI:1447909734
Name:BEAM, ELIZABETH (MD, PHD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BEAM
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:
Other - Last Name:BEAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:PO BOX 620689
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:94062-0689
Mailing Address - Country:US
Mailing Address - Phone:440-382-7518
Mailing Address - Fax:
Practice Address - Street 1:401 QUARRY RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1419
Practice Address - Country:US
Practice Address - Phone:559-165-0725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1903042084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA190304OtherPHYSICIAN'S AND SURGEON'S LICENSE