Provider Demographics
NPI:1952532012
Name:BEAUCHAMP, MARIEPROVI (MD)
Entity type:Individual
Prefix:DR
First Name:MARIEPROVI
Middle Name:
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 CALLE SAN FRANCISCO
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-2726
Mailing Address - Country:US
Mailing Address - Phone:787-487-4163
Mailing Address - Fax:
Practice Address - Street 1:75 CALLE SAN FRANCISCO
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-2726
Practice Address - Country:US
Practice Address - Phone:787-487-4163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17677208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice