Provider Demographics
NPI:1225343932
Name:BEAUMONT, MEGAN ALYSA (MD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ALYSA
Last Name:BEAUMONT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-493-6002
Mailing Address - Fax:425-493-6015
Practice Address - Street 1:4430 106TH ST SW
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-4711
Practice Address - Country:US
Practice Address - Phone:425-493-6002
Practice Address - Fax:425-493-6015
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD601700772080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8904765Medicare PIN