Provider Demographics
NPI:1891347266
Name:BECKWITH INTEGRATIVE MEDICINE, PLLC
Entity Type:Organization
Organization Name:BECKWITH INTEGRATIVE MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKWITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-687-4158
Mailing Address - Street 1:952 EDWARDS FERRY RD NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3324
Mailing Address - Country:US
Mailing Address - Phone:703-687-4158
Mailing Address - Fax:703-687-4159
Practice Address - Street 1:952 EDWARDS FERRY RD NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3324
Practice Address - Country:US
Practice Address - Phone:703-687-4158
Practice Address - Fax:703-687-4159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1235162280Medicaid
VA1326514316Other1326514316
VA1235162280Other1235162280
VA1326514316Medicaid