MEDICARE: MR. ROBERT BEAUDOUIN 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	207R00000X	Internal Medicine Physician	25 MA06795000	NJ

General Provider Information

NPI Number	:	1881833812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT BEAUDOUIN M.D.

Provider Business Mailing Address
First Line	:	80 29TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11232-1503
Country	:	US
Telephone Number	:	718-840-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 29TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11232-1503
Country	:	US
Telephone Number	:	718-840-4200
Fax Number	:

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

Provider Enumeration Date	:	02/15/2009
Last Update Date	:	02/15/2009

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