Individual
GLADYS A. BEALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1720 BEACON ST, FORT WAYNE, IN 46805-4749
(260) 373-8000
(260) 373-8034
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
(260) 266-6013
Taxonomy
Speciality
Code
Description
License number
State
2084F0202X
Forensic Psychiatry Physician
Primary
01052426A
IN
2084P0804X
Child & Adolescent Psychiatry Physician
01052426A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000543920
ANTHEM
IN
05
—
200274420
—
IN
05
—
2566067
—
OH
01
—
260043528
RAILROAD MEDICARE
—
01
—
P00466953
RAILROAD MEDICARE
IN
Enumeration date
01/10/2006
Last updated
10/11/2022
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