Provider Demographics
NPI:1689959538
Name:BEACON PEDIATRICS LLC
Entity Type:Organization
Organization Name:BEACON PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GIDEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-645-8212
Mailing Address - Street 1:18947 JOHN J WILLIAMS HWY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-4474
Mailing Address - Country:US
Mailing Address - Phone:302-645-8212
Mailing Address - Fax:302-645-2199
Practice Address - Street 1:18947 JOHN J WILLIAMS HWY
Practice Address - Street 2:SUITE 212
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-4474
Practice Address - Country:US
Practice Address - Phone:302-645-8212
Practice Address - Fax:302-645-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty