Basic Information
| Provider Information | |||||||||
| NPI: | 1205888997 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEACH | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 71690 | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232551690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042852300 | ||||||||
| FaxNumber: | 8042858420 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 MAPLE AVE | ||||||||
| Address2: | NW MOB SUITE 200 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232262553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042852300 | ||||||||
| FaxNumber: | 8042858420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 08/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 0101046574 | VA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 174400000X | 0101046574 | VA | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 227701 | 01 | VI | ANTHEM | OTHER | 200008450 | 01 | GEORGIA RR MEDICARE | OTHER |