Healthcare Provider Details

I. General information

NPI: 1114194024
Provider Name (Legal Business Name): BEAUFORT REGIONAL PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E 11TH ST
WASHINGTON NC
27889-3761
US

IV. Provider business mailing address

601 E 11TH ST
WASHINGTON NC
27889-3761
US

V. Phone/Fax

Practice location:
  • Phone: 252-946-0835
  • Fax: 252-946-1796
Mailing address:
  • Phone: 252-946-0835
  • Fax: 252-946-1796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSAN S GERARD
Title or Position: PHSYICIAN PRACTICE ADMINISTRATOR
Credential:
Phone: 252-975-4203