Healthcare Provider Details

I. General information

NPI: 1811060841
Provider Name (Legal Business Name): SCOTT ALAN BEUOY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WASHINGTON ST BOX 266
BOSTON MA
02111-1526
US

IV. Provider business mailing address

15 MERMAID AVE
WINTHROP MA
02152-1122
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5594
  • Fax:
Mailing address:
  • Phone: 617-846-8760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1757
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: