Provider Demographics
NPI:1023018959
Name:BEACH, MICHAEL D (CRNP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:BEACH
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 VICTORIA BUILDING
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15261-2403
Mailing Address - Country:US
Mailing Address - Phone:412-624-9654
Mailing Address - Fax:
Practice Address - Street 1:336 VICTORIA BUILDING
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15261-2403
Practice Address - Country:US
Practice Address - Phone:412-624-9654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP007013M363LA2100X
PASP008614363LP0200X
OHAPRN.CNP.06674363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN342536LOtherREG NURSE
OHH298392Medicare PIN
PA500023126Medicare PIN
PA054915NJRMedicare PIN
PAP50708Medicare UPIN
PACG2176Medicare PIN
PA500023126Medicare PIN