Provider Demographics
NPI:1922233691
Name:BECKHAM, CARLA JOLENE (MD/PHD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:JOLENE
Last Name:BECKHAM
Suffix:
Gender:F
Credentials:MD/PHD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:711 TROY SCHENECTADY RD STE 119
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2454
Practice Address - Country:US
Practice Address - Phone:518-786-9131
Practice Address - Fax:518-786-9136
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY267759208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04203605Medicaid
NYJ400233371OtherMEDICARE