Zachary Robert Beaulieu

Key facts

NPI

1114751633

Entity type

Individual (NPI type 1)

Primary specialty

Student in an Organized Health Care Education/Training Program 390200000X

License

088654-21 (NH)

Practice address

716 Stevens Ave
Portland, ME 04103-2693

Phone

(207) 221-4516

NPI assigned

Aug 27, 2024

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 27, 2024.

{
    "created_epoch": "1724716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1114751633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 1/2 EAST ST",
            "city": "DOVER",
            "state": "NH",
            "postal_code": "038203135",
            "telephone_number": "860-306-3818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 STEVENS AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041032693",
            "telephone_number": "207-221-4516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAULIEU",
        "first_name": "ZACHARY",
        "middle_name": "ROBERT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-27",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NH",
            "license": "088654-21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

• Jay Alan Beauchemin, D.D.S.
• Miranda Beaudoin
• Jennifer L Beaule, M.S. ED.
• Danielle R Beaulieu
• Sara Beaulieu, LMSW-CC
• Danielle Beaumont
• Maria Beauregard
• Meredith Beauregard, PA
• Eric A Beaver, PA-C
• Sophia Catherine Bechek, MD

All providers in Portland, ME · Student in an Organized Health Care Education/Training Program in Maine