MEDICARE: ROBERT J BEAULIEU

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1801681929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT J BEAULIEU

Provider Business Mailing Address
First Line	:	30 LEON ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-5009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	270 HUNTINGTON AVE APT 304
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-4613
Country	:	US
Telephone Number	:	617-791-4993
Fax Number	:

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

Provider Enumeration Date	:	04/10/2025
Last Update Date	:	04/10/2025

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