Provider Demographics
NPI:1356554141
Name:BEASLEY, DARREN S (MD)
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:S
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 1:620 JOHN PAUL JONES CIR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708-2111
Mailing Address - Country:US
Mailing Address - Phone:757-953-7550
Mailing Address - Fax:757-953-7560
Practice Address - Street 1:160 MAIN RD BLDG 1971
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23691-5111
Practice Address - Country:US
Practice Address - Phone:757-953-8407
Practice Address - Fax:757-953-9600
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243550207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNGRP6388Medicare PIN
TN103I937640Medicare PIN
OHH264220Medicare PIN
TNP00945772Medicare PIN
TNDE5194Medicare PIN
OH9379701Medicare PIN