Provider Demographics
NPI:1871602144
Name:BEAUCHAMP, MAGDA M (MD)
Entity type:Individual
Prefix:DR
First Name:MAGDA
Middle Name:M
Last Name: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 1:916 WESTLAND CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-6726
Mailing Address - Country:US
Mailing Address - Phone:720-308-7319
Mailing Address - Fax:
Practice Address - Street 1:101 FORT SANDERS WEST BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3342
Practice Address - Country:US
Practice Address - Phone:865-895-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN62121208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14J38OtherBCBS OF FLORIDA
FL003902600Medicaid
FL003902600Medicaid
FLFG230ZMedicare PIN