Basic Information
| Provider Information | |||||||||
| NPI: | 1376854422 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEACH | ||||||||
| FirstName: | CHEYENNE | ||||||||
| MiddleName: | MACNARY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 PARK STREET | ||||||||
| Address2: | YALE NEW HAVEN HOSPITAL WP2 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037854081 | ||||||||
| FaxNumber: | 2037377635 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 PARK STREET | ||||||||
| Address2: | YALE NEW HAVEN HOSPITAL WP2 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037854081 | ||||||||
| FaxNumber: | 2037377635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2010 | ||||||||
| LastUpdateDate: | 04/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MT197577 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 4301108945 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 56318 | CT | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0202X | 4301108945 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | 2080P0202X | 56318 | CT | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
No ID Information.