Healthcare Provider Details

I. General information

NPI: 1427346568
Provider Name (Legal Business Name): BEACON GROUPS HEALTHCARE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 TREMONT ST SUITE 5
BOSTON MA
02111-1020
US

IV. Provider business mailing address

177 TREMONT ST. SUITE 5
BOSTON MA
02111-1020
US

V. Phone/Fax

Practice location:
  • Phone: 617-417-9622
  • Fax: 617-553-1976
Mailing address:
  • Phone: 617-417-9622
  • Fax: 617-553-1976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number234282
License Number StateMA

VIII. Authorized Official

Name: DR. NICOLE LOUISE TOUCHET
Title or Position: FAMILY PRACTICE
Credential: M.D.
Phone: 617-417-9622