Healthcare Provider Details

I. General information

NPI: 1972450245
Provider Name (Legal Business Name): MADELINE ROCQUE BEAULIEU DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901ROCKVILLE PIKE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

229 NOYES RD
VESTAL NY
13850-5617
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: