Healthcare Provider Details

I. General information

NPI: 1124986989
Provider Name (Legal Business Name): JOSHUA MICHAEL BEACH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11110 MEDICAL CAMPUS RD STE 200
HAGERSTOWN MD
21742-6797
US

IV. Provider business mailing address

8821 HILLSIDE WAY
WAYNESBORO PA
17268-7617
US

V. Phone/Fax

Practice location:
  • Phone: 301-714-4400
  • Fax: 301-714-4424
Mailing address:
  • Phone: 240-446-6244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR272219
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: