Provider Demographics
NPI:1396861985
Name:BEAUFAIT, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:BEAUFAIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2613
Mailing Address - Country:US
Mailing Address - Phone:603-632-5600
Mailing Address - Fax:603-632-5477
Practice Address - Street 1:411 U.S. ROUTE 4
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:NH
Practice Address - Zip Code:03748
Practice Address - Country:US
Practice Address - Phone:603-632-5600
Practice Address - Fax:603-632-5477
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT743054927OtherVERMONT BLUE SHIELD
NH0105271YPNH01OtherBLUE SHIELD
NH81080107Medicaid
NH0105271YPNH01OtherBLUE SHIELD
NHB86234Medicare UPIN