Provider Demographics
NPI:1275628497
Name:BEACH, KATHLEEN J (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:J
Last Name:BEACH
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 1:115 CROSS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-1498
Mailing Address - Country:US
Mailing Address - Phone:919-483-7371
Mailing Address - Fax:
Practice Address - Street 1:GLAXO SMITH KLINE
Practice Address - Street 2:FIVE MOORE DRIVE
Practice Address - City:RTP
Practice Address - State:NC
Practice Address - Zip Code:27709
Practice Address - Country:US
Practice Address - Phone:919-483-7371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75317207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine