Provider Demographics
NPI:1194118422
Name:ABAO-BEAUCHAMP, ANNE MARIE BOLIVAR (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE MARIE
Middle Name:BOLIVAR
Last Name:ABAO-BEAUCHAMP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ARLEY WAY STE 201B
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4883
Mailing Address - Country:US
Mailing Address - Phone:843-757-7700
Mailing Address - Fax:843-757-7702
Practice Address - Street 1:11 ARLEY WAY STE 201B
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4883
Practice Address - Country:US
Practice Address - Phone:843-757-7700
Practice Address - Fax:843-757-7702
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC84047208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014994300Medicaid