Healthcare Provider Details

I. General information

NPI: 1396861985
Provider Name (Legal Business Name): DAVID W BEAUFAIT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 U.S. ROUTE 4
ENFIELD NH
03748
US

IV. Provider business mailing address

252 MECHANIC ST
LEBANON NH
03766-2613
US

V. Phone/Fax

Practice location:
  • Phone: 603-632-5600
  • Fax: 603-632-5477
Mailing address:
  • Phone: 603-632-5600
  • Fax: 603-632-5477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6754
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: