Healthcare Provider Details

I. General information

NPI: 1043494156
Provider Name (Legal Business Name): BEACH MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 PLEASUREHOUSE RD #105
VIRGINIA BEACH VA
23455
US

IV. Provider business mailing address

1801 PLEASUREHOUSE ROAD #105
VIRGINIA BEACH VA
23455
US

V. Phone/Fax

Practice location:
  • Phone: 757-363-8571
  • Fax: 757-363-8239
Mailing address:
  • Phone: 757-363-8571
  • Fax: 757-363-8239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104001533
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0104001533
License Number StateVA

VIII. Authorized Official

Name: MRS. MARILYN TODESCA
Title or Position: MEDICAL BILLER
Credential:
Phone: 757-363-8571