Healthcare Provider Details

I. General information

NPI: 1639199912
Provider Name (Legal Business Name): JANET L BEAUSOLEIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E LANCASTER AVE STE 200
ARDMORE PA
19003-2395
US

IV. Provider business mailing address

233 E LANCASTER AVE STE 200
ARDMORE PA
19003-2395
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1000
  • Fax: 215-561-0959
Mailing address:
  • Phone: 610-642-1643
  • Fax: 610-642-0245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD066113L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberMD066113L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD66113L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: