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NPI Code Detail

MEDICARE: DR. LUTHUR BEAZLEY M.D.

MEDICARE: DR. LUTHUR BEAZLEY 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
1208000000XPediatrics Physician0101031968VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841299575
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LUTHUR BEAZLEY M.D.
Provider Business Mailing Address
First Line : 1802 BRAEBURN DR
Second Line :
City : SALEM
State : VA
Zip : 24153-7357
Country : US
Telephone Number : 540-772-3580
Fax Number : 540-725-5012
Provider Business Practice Location Address
First Line : 1802 BRAEBURN DR
Second Line :
City : SALEM
State : VA
Zip : 24153-7357
Country : US
Telephone Number : 540-772-3580
Fax Number : 540-725-5012
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2005
Last Update Date : 05/07/2010

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Directions to “ DR. LUTHUR BEAZLEY M.D.” Practice Location

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