Individual
DR. MICHAEL ALAN BEASLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(215) 590-1000
(267) 876-2181
Mailing address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(215) 590-1000
(267) 876-8121
Taxonomy
Speciality
Code
Description
License number
State
2080S0010X
Pediatric Sports Medicine Physician
Primary
MD483528
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104285805
—
PA
01
—
247169
MASSACHUSETTS LICENSE
MA
05
—
525196
—
AZ
01
—
900001779
EMPLOYEE NUMBER
AZ
Enumeration date
11/13/2009
Last updated
11/06/2024
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