Provider Demographics
NPI:1235162280
Name:BECKWITH, MATTHEW GREY (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:GREY
Last Name:BECKWITH
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 1:24 N WALNUT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-4741
Mailing Address - Country:US
Mailing Address - Phone:240-452-3400
Mailing Address - Fax:
Practice Address - Street 1:24 N WALNUT ST STE 100
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4741
Practice Address - Country:US
Practice Address - Phone:240-452-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO53634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400400100Medicaid
MD400400100Medicaid
MD400400100Medicaid