Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD018467E | PA |
NPI | 1013092519 |
---|---|
Provider Name | Dr. Mark Edward Beaugard |
First Address | West Chester, PA 19380-4434 |
Second Address | West Chester, PA 19380-4434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 29/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7209230000 | (05) | PA |
B39887 | (02) |