Provider Demographics
NPI:1184682544
Name:BEAUDETT, MALCOLM STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:STEPHEN
Last Name:BEAUDETT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:278 LAFAYETTE ROAD
Mailing Address - Street 2:BUILDING E
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:603-436-6887
Mailing Address - Fax:603-431-1991
Practice Address - Street 1:278 LAFAYETTE ROAD
Practice Address - Street 2:BUILDING E
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-436-6887
Practice Address - Fax:603-436-5530
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2022-11-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH72462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHNH9329Medicare ID - Type Unspecified