Provider Demographics
NPI:1184894719
Name:BEASLEY, DORIAN LEENARD (MD)
Entity type:Individual
Prefix:DR
First Name:DORIAN
Middle Name:LEENARD
Last Name:BEASLEY
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 1:6626 E 75TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 CORWIN LN
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6612
Practice Address - Country:US
Practice Address - Phone:765-453-8567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060867A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200946320Medicaid
INP01456983OtherRAILROAD PTAN
INP00786928OtherRAILROAD MEDICARE
INP00804358OtherRAILROAD MEDICARE
INP01105075Medicare PIN
INM400046381Medicare PIN
IN266180481Medicare PIN
INP00804358OtherRAILROAD MEDICARE
IN200946320Medicaid
ININ1663070Medicare PIN