Provider Demographics
NPI:1013092519
Name:BEAUGARD, MARK EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:BEAUGARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:520 MAPLE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4434
Mailing Address - Country:US
Mailing Address - Phone:610-692-0800
Mailing Address - Fax:610-692-8299
Practice Address - Street 1:520 MAPLE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4434
Practice Address - Country:US
Practice Address - Phone:610-692-0800
Practice Address - Fax:610-692-8299
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD018467E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7209230000Medicaid
B39887Medicare UPIN