Provider Demographics
NPI:1902808124
Name:BEAUDOIN, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:BEAUDOIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:260 MERRIMAC ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2192
Mailing Address - Country:US
Mailing Address - Phone:978-499-7200
Mailing Address - Fax:978-499-7216
Practice Address - Street 1:260 MERRIMAC ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2192
Practice Address - Country:US
Practice Address - Phone:978-499-7200
Practice Address - Fax:978-499-7216
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA70450207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA070450OtherTUFTS HEALTH PLAN
NHE71908OtherANTHEM BLUE CROSS
110214704OtherRAILROAD MEDICARE
73374OtherHEALTHSOURCE
04-08373OtherEVERCARE
974551OtherNETWORK HEALTH
MAJ10622OtherBLUE CROSS BLUE SHIELD
1902808124OtherAETNA - HMO
NH30005433OtherNEW HAMPSHIRE MEDICAID
MA60722OtherHARVARD PILGRIM HEALTHCAR
MA110049133AMedicaid
2876947OtherCIGNA
5305442OtherAETNA - NON-HMO
974551OtherNETWORK HEALTH
MAJ1062202Medicare PIN