Provider Demographics
NPI:1972612133
Name:BEACH, LAURIE JEANNE (MD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:JEANNE
Last Name:BEACH
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 1:131 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8522
Mailing Address - Country:US
Mailing Address - Phone:704-662-0877
Mailing Address - Fax:704-662-0875
Practice Address - Street 1:131 MEDICAL PARK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8522
Practice Address - Country:US
Practice Address - Phone:704-662-0877
Practice Address - Fax:704-662-0875
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC37789174400000X
SC17971207L00000X
VA0101284574207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913986Medicaid
NC13986OtherBCBS
NC8913986Medicaid
NCE10612Medicare UPIN
NC8913986Medicaid