Provider Demographics
NPI:1114996733
Name:BECKWITH, DOUGLAS E (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:E
Last Name:BECKWITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8580 MAGELLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1149
Mailing Address - Country:US
Mailing Address - Phone:804-796-2373
Mailing Address - Fax:804-748-9160
Practice Address - Street 1:12901 BRIGGS RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-5335
Practice Address - Country:US
Practice Address - Phone:804-796-2373
Practice Address - Fax:804-748-9160
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101045691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1114996733Medicaid
VA005629764Medicaid
080006421Medicare ID - Type Unspecified