Provider Demographics
NPI:1154314797
Name:BECK, AGUSTUS A (MD)
Entity Type:Individual
Prefix:
First Name:AGUSTUS
Middle Name:A
Last Name:BECK
Suffix:
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 1:100 SEVENH AVE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024
Mailing Address - Country:US
Mailing Address - Phone:440-285-2300
Mailing Address - Fax:440-285-2320
Practice Address - Street 1:100 SEVENH AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024
Practice Address - Country:US
Practice Address - Phone:440-285-2300
Practice Address - Fax:440-285-2320
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-084701207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD036689700Medicaid
MD186168YYTMedicare PIN
OHBE4161242Medicare ID - Type Unspecified
MD036689700Medicaid