Provider Demographics
NPI:1376105049
Name:BEAULIEU, ALEC (PA-C)
Entity type:Individual
Prefix:MR
First Name:ALEC
Middle Name:
Last Name:BEAULIEU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 DAN RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2852
Mailing Address - Country:US
Mailing Address - Phone:781-867-2050
Mailing Address - Fax:
Practice Address - Street 1:45 DAN RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2852
Practice Address - Country:US
Practice Address - Phone:781-867-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA7132363A00000X
NH1525363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3119149Medicaid