Provider Demographics
NPI:1376547786
Name:BEAUREGARD, LOU-ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LOU-ANNE
Middle Name:
Last Name:BEAUREGARD
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 1:901 W MAIN ST STE 205
Mailing Address - Street 2:CN5050
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2537
Mailing Address - Country:US
Mailing Address - Phone:732-866-0800
Mailing Address - Fax:732-866-0018
Practice Address - Street 1:901 W MAIN ST STE 205
Practice Address - Street 2:CN5050
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2537
Practice Address - Country:US
Practice Address - Phone:732-866-0800
Practice Address - Fax:732-866-0018
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46668207RC0000X
NJ46668207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
060046368OtherRR MEDICARE
NJ4114442OtherAETNA PPO
NJ60006205OtherHORIZON NJ HEALTH
NJ662704Medicaid
NJ83286OtherAMERICAID / AMERIGROUP
NJ0519147OtherAETNA HMO
NJ5714791OtherGHI PPO
F07151OtherHEALTHNET
P376633OtherOXFORD
NJ0519147OtherAETNA HMO
NJ662704Medicaid