Provider Demographics
NPI:1134190069
Name:BEACH, DENISE (DPM)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:BEACH
Suffix:
Gender:F
Credentials:DPM
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 421
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-0421
Mailing Address - Country:US
Mailing Address - Phone:410-945-5400
Mailing Address - Fax:410-566-8219
Practice Address - Street 1:201 MILFORD MILL RD STE 201
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-5923
Practice Address - Country:US
Practice Address - Phone:410-945-5400
Practice Address - Fax:410-566-8219
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01256174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4494380001Medicare NSC