Provider Demographics
NPI:1114904661
Name:BEAUCHAMP, DONALD P (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:P
Last Name:BEAUCHAMP
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 1:7400 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5612
Mailing Address - Country:US
Mailing Address - Phone:718-236-9446
Mailing Address - Fax:718-236-3854
Practice Address - Street 1:7400 18TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5612
Practice Address - Country:US
Practice Address - Phone:718-236-9446
Practice Address - Fax:718-236-3854
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228475-2207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2411549Medicaid
NY5180D2Medicare ID - Type Unspecified
NYH94772Medicare UPIN