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General NPI Number Information
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NPI Number | 1972612133
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Entity Type | Individual
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Provider Name | LAURIE JEANNE BEACH MD
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 131 MEDICAL PARK RD SUITE 201
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City | MOORESVILLE
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State | NC
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Zip | 28117-8522
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Country | US
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Telephone | 704-662-0877
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Fax | 704-662-0875
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Provider Business Mailing Address
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Address Line | 131 MEDICAL PARK RD SUITE 201
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City | MOORESVILLE
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State | NC
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Zip | 28117-8522
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Country | US
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Telephone | 704-662-0877
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Fax | 704-662-0875
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 37789
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 17971
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0101284574
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License Number State | VA
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