Basic Information
| Provider Information | |||||||||
| NPI: | 1851303655 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEAUPRE | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 362 BEDFORD STREET | ||||||||
| Address2: | |||||||||
| City: | EAST BRIDGEWATER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023331465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083502350 | ||||||||
| FaxNumber: | 5083502318 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 COMPASS WAY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | EAST BRIDGEWATER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023331465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083502300 | ||||||||
| FaxNumber: | 5083502307 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 03/07/2016 | ||||||||
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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 | 207Q00000X | 216381 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 714257 | 01 | MA | HPHC | OTHER | A3514801 | 01 | MA | MEDICARE PTAN | OTHER | J25977 | 01 | MA | MABC | OTHER | 216381 | 01 | MA | TUFTS | OTHER | 0103384 | 01 | UHC | OTHER | 6102254001 | 01 | MA | CIGNA | OTHER | 2005808 | 05 | MA | MEDICAID |