Provider Demographics
NPI:1194908251
Name:BEACH MEDICAL GROUP, PC
Entity type:Organization
Organization Name:BEACH MEDICAL GROUP, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:TODESCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-363-8571
Mailing Address - Street 1:1801 PLEASURE HOUSE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-2864
Mailing Address - Country:US
Mailing Address - Phone:757-363-8571
Mailing Address - Fax:757-363-8239
Practice Address - Street 1:1801 PLEASURE HOUSE RD STE 105
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-2864
Practice Address - Country:US
Practice Address - Phone:757-363-8571
Practice Address - Fax:757-363-8239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA118946OtherBLUE CROSS