Provider Demographics
NPI:1053342600
Name:BEACH, JONATHAN CHARLES (DO)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CHARLES
Last Name:BEACH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 DEVIL'S DEN RD
Mailing Address - Street 2:P.O. BOX 273
Mailing Address - City:ALTONA
Mailing Address - State:NY
Mailing Address - Zip Code:12910
Mailing Address - Country:US
Mailing Address - Phone:518-236-5611
Mailing Address - Fax:
Practice Address - Street 1:16 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-1126
Practice Address - Country:US
Practice Address - Phone:603-228-2239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228601207P00000X, 207Q00000X
NH19288207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RA6763Medicare ID - Type Unspecified
I11487Medicare UPIN