Provider Demographics
NPI:1255350948
Name:BEECHER, WALTER STEWART (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:STEWART
Last Name:BEECHER
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 1:480 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-3634
Mailing Address - Country:US
Mailing Address - Phone:585-436-3040
Mailing Address - Fax:585-295-6009
Practice Address - Street 1:480 GENESEE ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-3634
Practice Address - Country:US
Practice Address - Phone:585-436-3040
Practice Address - Fax:585-295-6009
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY139048Medicaid
NY102331BFOtherPREFERRED CARE
NY01258259Medicaid
NY6281OtherBLUE CROSS ROCHESTER
NYP010139048OtherBLUE CHOICE
NY080074824OtherRAILROAD MEDICARE
NY01258259Medicaid
NYP010139048OtherBLUE CHOICE
NY10690BMedicare ID - Type Unspecified