Provider Demographics
NPI:1043474364
Name:BEAULIEU, KEITH ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ALLEN
Last Name:BEAULIEU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 N DUKE ST
Mailing Address - Street 2:SUITE 244
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2374
Mailing Address - Country:US
Mailing Address - Phone:717-544-4930
Mailing Address - Fax:717-544-4964
Practice Address - Street 1:540 N DUKE ST
Practice Address - Street 2:SUITE 244
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2374
Practice Address - Country:US
Practice Address - Phone:717-544-4930
Practice Address - Fax:717-544-4964
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT182532207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023706850001Medicaid
PA1023706850001Medicaid