Beasley, Michael Alan

Beasley, Michael Alan is an individual health care provider with primary practice located at 319 Longwood Ave Dept Of Sports Medicine, Boston MA 02115-5728. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is his primary health care specialty. Beasley, Michael Alan can be contacted via phone (617) 355-8597.

Contact Information

Primary practice address
319 Longwood Ave Dept Of Sports Medicine Boston MA 02115-5728
Phone: (617) 355-8597
Fax: (617) 730-4712
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 247169 Massachusetts
Allopathic & Osteopathic Physicians / Pediatrics 208000000X R70720 Arizona
Allopathic & Osteopathic Physicians / Sports Medicine 2080S0010X 247169 Massachusetts

Profile Details

NPI number 1407183353
LBN Legal business name Beasley, Michael Alan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 13th, 2009
Last updated Sep 23rd, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407183353 NPPES
Arizona MEDICAID 525196
Arizona Other 247169
Arizona Other 900001779

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