Healthcare Provider Details

I. General information

NPI: 1023094893
Provider Name (Legal Business Name): BRIAN ALBERT BEATTIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MIDDLE ST
LANCASTER NH
03584-3556
US

IV. Provider business mailing address

170 MIDDLE ST
LANCASTER NH
03584-3556
US

V. Phone/Fax

Practice location:
  • Phone: 603-788-2521
  • Fax: 603-788-5027
Mailing address:
  • Phone: 603-788-2521
  • Fax: 603-788-5027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5060
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: