Provider Demographics
NPI:1336108380
Name:CHESTER FAMILY MEDCARE PC
Entity Type:Organization
Organization Name:CHESTER FAMILY MEDCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:BECKWITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-796-2373
Mailing Address - Street 1:12901 BRIGGS RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-5335
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C05516OtherGROUP MEDICARE NUMBER