Healthcare Provider Details

I. General information

NPI: 1508023854
Provider Name (Legal Business Name): LAURENT J BEAUREGARD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 WHITING HILL RD CIANCHETTE BUILDING, SUITE 150
BREWER ME
04412-1005
US

IV. Provider business mailing address

43 WHITING HILL RD CIANCHETTE BUILDING, SUITE 150
BREWER ME
04412-1005
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-7357
  • Fax: 207-973-5640
Mailing address:
  • Phone: 207-973-7357
  • Fax: 207-973-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: