MEDICARE: DARREN S BEASLEY MD

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	207P00000X	Emergency Medicine Physician	0101243550	VA

General Provider Information

NPI Number	:	1356554141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARREN S BEASLEY MD

Provider Business Mailing Address
First Line	:	620 JOHN PAUL JONES CIR
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23708-2111
Country	:	US
Telephone Number	:	757-953-7550
Fax Number	:	757-953-7560

Provider Business Practice Location Address
First Line	:	160 MAIN RD BLDG 1971
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23691-5111
Country	:	US
Telephone Number	:	757-953-8407
Fax Number	:	757-953-9600

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	10/26/2020

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