Provider Demographics
NPI:1821046939
Name:BEAUCHAMP, ALFREDO (MD)
Entity Type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:
Last Name:BEAUCHAMP
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:PO BOX 5327
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-5327
Mailing Address - Country:US
Mailing Address - Phone:787-653-5353
Mailing Address - Fax:787-653-5364
Practice Address - Street 1:DEGETAU AVE. A17 SAN ALFONSO
Practice Address - Street 2:BOX5327
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726-5327
Practice Address - Country:US
Practice Address - Phone:787-653-5353
Practice Address - Fax:787-653-5364
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006678207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8000565OtherHUMANA
998035OtherMEDICARE MUCHO MAS
068430OtherCRUZ AZUL
28527BEOtherSSS
3643OtherPREFERRED MEDICARE CHOICE
0028527Medicare ID - Type Unspecified
8000565OtherHUMANA