Individual
CHARLES IVES BEAUDETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4092 FOXWOOD DR, STE 101, VA BEACH, VA 23462-5225
(757) 686-3508
(757) 686-0541
Mailing address
PO BOX 7549, PORTSMOUTH, VA 23707-0549
(757) 686-3508
(757) 686-0541
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101255172
VA
207P00000X
Emergency Medicine Physician
265337
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03462517
—
NY
Enumeration date
05/21/2009
Last updated
11/17/2015
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