Healthcare Provider Details

I. General information

NPI: 1528076247
Provider Name (Legal Business Name): ERIC ROBERT BEAUDOIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CHAPEL ST
NEW HAVEN CT
06511-4405
US

IV. Provider business mailing address

1423 CHAPEL ST
NEW HAVEN CT
06511-4411
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-3538
  • Fax:
Mailing address:
  • Phone: 203-789-3538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number038717
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: