Provider Demographics
NPI:1558345579
Name:BECKETT, EDWARD CHARLES III (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:CHARLES
Last Name:BECKETT
Suffix:III
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:215 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-2163
Mailing Address - Country:US
Mailing Address - Phone:610-377-2490
Mailing Address - Fax:610-377-6744
Practice Address - Street 1:525 IRON ST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1912
Practice Address - Country:US
Practice Address - Phone:610-377-8228
Practice Address - Fax:610-377-2518
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002411L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
20944OtherGEISINGER
PA0008589350002Medicaid
50083415OtherBLUE CROSS
PA480033138OtherRAILROAD MEDICARE #
PA000081724OtherBLUE SHIELD
PA0817242B9AOtherMEDICARE