Provider Demographics
NPI:1588608384
Name:BEAULIEU, BRIAN L (M D)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:L
Last Name:BEAULIEU
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:20 YORK STREET, CB-329
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-384-4677
Mailing Address - Fax:203-384-3135
Practice Address - Street 1:300 SEASIDE AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460
Practice Address - Country:US
Practice Address - Phone:203-301-1070
Practice Address - Fax:203-301-1542
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT039988207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11448959OtherCAQH
CTH72184Medicare UPIN
11448959OtherCAQH