Provider Demographics
NPI:1548401128
Name:BEAUDOIN, STEPHEN THOMAS (CO)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:THOMAS
Last Name:BEAUDOIN
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5L RICHARDSON DR
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-4920
Mailing Address - Country:US
Mailing Address - Phone:603-216-1294
Mailing Address - Fax:
Practice Address - Street 1:5L RICHARDSON DR
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-4920
Practice Address - Country:US
Practice Address - Phone:603-216-1294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2978332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies