Provider Demographics
NPI:1114954872
Name:BEASLEY, CAREN DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAREN
Middle Name:DENISE
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 W WENDOVER AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-8117
Mailing Address - Country:US
Mailing Address - Phone:336-832-3110
Mailing Address - Fax:336-832-3111
Practice Address - Street 1:1307 W WENDOVER AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408
Practice Address - Country:US
Practice Address - Phone:336-832-3110
Practice Address - Fax:336-832-3111
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-01010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine