Basic Information
Provider Information | |||||||||
NPI: | 1437129624 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BEAUBOEUF | ||||||||
FirstName: | ANDRE | ||||||||
MiddleName: | F | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 160 | ||||||||
Address2: | PATIENT FINANCIAL SERVICES | ||||||||
City: | LITTLETON | ||||||||
State: | NH | ||||||||
PostalCode: | 03561 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6032597627 | ||||||||
FaxNumber: | 6032597561 | ||||||||
Practice Location | |||||||||
Address1: | 600 ST. JOHNSBURY RD. | ||||||||
Address2: |   | ||||||||
City: | LITTLETON | ||||||||
State: | NH | ||||||||
PostalCode: | 03561 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6034449000 | ||||||||
FaxNumber: | 6035272984 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/23/2006 | ||||||||
LastUpdateDate: | 08/21/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 11345 | NH | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 01Y003351NH01 | 01 | NH | ANTHEM | OTHER | 45050 | 01 | NH | HARVARD PILGRIM HEALTHCAR | OTHER | 30201692 | 05 | NH |   | MEDICAID | 4126673 | 01 | NH | MVP | OTHER | 8983987 | 01 | NH | CIGNA | OTHER |