Healthcare Provider Details

I. General information

NPI: 1730685173
Provider Name (Legal Business Name): BEVERLY CLAIRE TSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-2804
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-8085
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-3387
  • Fax:
Mailing address:
  • Phone: 860-679-2792
  • Fax: 860-679-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA163428
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number75570
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number75721
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: