Healthcare Provider Details

I. General information

NPI: 1770672552
Provider Name (Legal Business Name): MARK DAVID BEACHLER CP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WRAMC STE 3H 6900 GEORGIA AVE NW
WASHINGTON DC
20307-0001
US

IV. Provider business mailing address

7312 FLOWER AVE
TAKOMA PARK MD
20912-6429
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-9830
  • Fax: 202-782-4365
Mailing address:
  • Phone: 504-439-4036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberCP2980
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: