Provider Demographics
NPI:1881767416
Name:BEAUCHESNE, JOHN ALBERT (PAC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALBERT
Last Name:BEAUCHESNE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 OLIN DR
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-7020
Mailing Address - Country:US
Mailing Address - Phone:978-343-6544
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE AVE NORTH
Practice Address - Street 2:UMASS MEMORIAL HEALTH CARE DEPT OF ADOLESCENT MEDICINE
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-856-5624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA352363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant