MEDICARE: BEACON MD LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	2084N0400X	Neurology Physician
3	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
4	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1710734496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON MD LLC

Provider Business Mailing Address
First Line	:	2011 S 25TH ST STE 105
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4795
Country	:	US
Telephone Number	:	772-229-4770
Fax Number	:

Provider Business Practice Location Address
First Line	:	2011 S 25TH ST STE 106
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4795
Country	:	US
Telephone Number	:	772-229-4770
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AJAY GOYAL
Credential	:
Telephone Number	:	772-468-7020

Provider Enumeration Date	:	05/01/2024
Last Update Date	:	02/18/2026

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Directions to “BEACON MD LLC ” Practice Location

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