Provider Demographics
NPI:1558467456
Name:BEACHLER, KENT J (MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:J
Last Name:BEACHLER
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 1:170 STATE ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-5756
Mailing Address - Country:US
Mailing Address - Phone:908-788-1802
Mailing Address - Fax:908-788-0049
Practice Address - Street 1:170 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5756
Practice Address - Country:US
Practice Address - Phone:908-788-1802
Practice Address - Fax:908-788-0049
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03759700207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ035838OtherUS HEALTH CARE
NJ38730901-03Medicaid
NJ415025OtherCIGNA
NJ37597OtherAETN
NJ38730901-03Medicaid
NJC56505Medicare UPIN