Healthcare Provider Details

I. General information

NPI: 1750366977
Provider Name (Legal Business Name): DOUGLAS M BEACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE KSB-23/BIDMC
BOSTON MA
02215-5400
US

IV. Provider business mailing address

330 BROOKLINE AVE KSB-23/BIDMC
BOSTON MA
02215-5400
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-5864
  • Fax: 617-667-4849
Mailing address:
  • Phone: 617-667-5864
  • Fax: 617-667-4849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number213449
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number213449
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number213449
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number213449
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: