MEDICARE: DR. CHARLES BRITTON BEASLEY JR. 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	2084P0800X	Psychiatry Physician	273356	NY
2	2084P0800X	Psychiatry Physician	MD453693	PA
3	390200000X	Student in an Organized Health Care Education/Training Program
4	2084P0800X	Psychiatry Physician	0101270868	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0101270868	OTHER	VA	VA LICENSE

General Provider Information

NPI Number	:	1356669337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES BRITTON BEASLEY JR. MD

Provider Business Mailing Address
First Line	:	3111 NORTHSIDE AVE STE 200
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-5441
Country	:	US
Telephone Number	:	267-417-9078
Fax Number	:

Provider Business Practice Location Address
First Line	:	3111 NORTHSIDE AVE STE 200
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-5441
Country	:	US
Telephone Number	:	804-625-4494
Fax Number	:

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

Provider Enumeration Date	:	05/14/2010
Last Update Date	:	06/16/2025

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