Healthcare Provider Details

I. General information

NPI: 1689778714
Provider Name (Legal Business Name): BEACON MEDICAL GROUP, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26744 JOHN J WILLIAMS HWY OAK ORCHARD PROF SUITES #3
MILLSBORO DE
19966-4667
US

IV. Provider business mailing address

26744 JOHN J WILLIAMS HWY OAK ORCHARD PROF SUITES #3
MILLSBORO DE
19966-4645
US

V. Phone/Fax

Practice location:
  • Phone: 302-947-9767
  • Fax: 302-947-9558
Mailing address:
  • Phone: 302-947-9767
  • Fax: 302-947-9558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY E HAWTOF
Title or Position: PRES
Credential: MD
Phone: 320-947-9767