MEDICARE: CARRIE Y, BEAUMONT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101240167	VA

General Provider Information

NPI Number	:	1033133814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE Y, BEAUMONT M.D.

Provider Business Mailing Address
First Line	:	1971 UNIVERSITY BLVD
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-2269
Country	:	US
Telephone Number	:	434-582-2514
Fax Number	:	434-582-2516

Provider Business Practice Location Address
First Line	:	1971 UNIVERSITY BLVD
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-2269
Country	:	US
Telephone Number	:	434-582-2514
Fax Number	:	434-582-2516

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	01/11/2010

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