=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689959538
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEACON PEDIATRICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2011
-----------------------------------------------------
Last Update Date | 05/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18947 JOHN J WILLIAMS HWY SUITE 212
-----------------------------------------------------
City | REHOBOTH BEACH
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19971-4474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-645-8212
-----------------------------------------------------
Fax | 302-645-2199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18947 JOHN J WILLIAMS HWY SUITE 212
-----------------------------------------------------
City | REHOBOTH BEACH
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19971-4474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-645-8212
-----------------------------------------------------
Fax | 302-645-2199
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/PRACTICE OWNER
-----------------------------------------------------
Name | DR. NANCY M GIDEON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 302-645-8212
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------