Healthcare Provider Details

I. General information

NPI: 1407045149
Provider Name (Legal Business Name): BEAUFORT REGIONAL PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 E. 12TH STREET
WASHINGTON NC
27889-3409
US

IV. Provider business mailing address

606 E. 12TH STREET
WASHINGTON NC
27889-3409
US

V. Phone/Fax

Practice location:
  • Phone: 252-940-6160
  • Fax:
Mailing address:
  • Phone: 252-940-6160
  • Fax:

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: PHYSICIAN PRACTICE ADMINISTRATOR
Credential:
Phone: 252-975-4203