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General NPI Number Information
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NPI Number | 1801177639
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Entity Type | Organization
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Legal Business Name | BEACH EAR NOSE THROAT PC
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Dates
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Enumeration Date | 09/07/2011
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Last Update Date | 12/27/2012
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Provider Practice Location Address
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Address Line | 1020 INDEPENDENCE BLVD SUITE 313
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City | VA BEACH
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State | VA
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Zip | 23455
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Country | US
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Telephone | 757-464-9165
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Fax | 757-464-4478
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Provider Business Mailing Address
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Address Line | 1020 INDEPENDENCE BLVD SUITE 313
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City | VA BEACH
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State | VA
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Zip | 23455
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Country | US
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Telephone | 757-464-9165
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Fax | 757-464-4478
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM SWAIN TEACHEY
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Credential | MD
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Telephone | 757-464-9165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 16027
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | ME17505
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 0101027211
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License Number State | VA
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