Provider Demographics
NPI:1003081936
Name:BECKETT, FREDERICK C III (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:C
Last Name:BECKETT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 CHEYNEY DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-7142
Mailing Address - Country:US
Mailing Address - Phone:813-505-8889
Mailing Address - Fax:
Practice Address - Street 1:484 TEMPLE HILL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-5557
Practice Address - Country:US
Practice Address - Phone:845-565-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247266207RP1001X, 207R00000X
FLME105774207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03733617Medicaid
NYA400092014Medicare PIN
NYA400092016Medicare PIN
FLCQ937ZMedicare UPIN