MEDICARE: DR. LOU-ANNE BEAUREGARD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	MA46668	NJ
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	46668	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	060046368	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	4114442	OTHER	NJ	AETNA PPO
3	60006205	OTHER	NJ	HORIZON NJ HEALTH
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	83286	OTHER	NJ	AMERICAID / AMERIGROUP
6	0519147	OTHER	NJ	AETNA HMO
7	5714791	OTHER	NJ	GHI PPO
8	F07151	OTHER		HEALTHNET
9	P376633	OTHER		OXFORD

General Provider Information

NPI Number	:	1376547786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOU-ANNE BEAUREGARD M.D.

Provider Business Mailing Address
First Line	:	901 W MAIN ST STE 205
Second Line	:	CN5050
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-2537
Country	:	US
Telephone Number	:	732-866-0800
Fax Number	:	732-866-0018

Provider Business Practice Location Address
First Line	:	901 W MAIN ST STE 205
Second Line	:	CN5050
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-2537
Country	:	US
Telephone Number	:	732-866-0800
Fax Number	:	732-866-0018

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	01/21/2014

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Directions to “ DR. LOU-ANNE BEAUREGARD M.D.” Practice Location

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