Provider Demographics
NPI:1780666800
Name:BECKMAN, CHARLES B (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:B
Last Name:BECKMAN
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 1:20 OLD MILLER LN
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1084
Mailing Address - Country:US
Mailing Address - Phone:203-457-1554
Mailing Address - Fax:
Practice Address - Street 1:46 PRINCE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1600
Practice Address - Country:US
Practice Address - Phone:203-867-5300
Practice Address - Fax:203-315-5320
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017701208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001177013Medicaid