Healthcare Provider Details

I. General information

NPI: 1386723484
Provider Name (Legal Business Name): WILLIAM R BEARDSLEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

27 SHEPARD ST
CAMBRIDGE MA
02138-1504
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6087
  • Fax: 617-730-0271
Mailing address:
  • Phone: 617-868-9666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number34475
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number34475
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: