Provider Demographics
NPI:1770812612
Name:BECKLES, WAYNE AGGREY (EDD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:AGGREY
Last Name:BECKLES
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 RUSSO WAY APT I
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6463
Mailing Address - Country:US
Mailing Address - Phone:301-377-1610
Mailing Address - Fax:
Practice Address - Street 1:6710 OXON HILL RD STE 202
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1124
Practice Address - Country:US
Practice Address - Phone:301-377-1610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD070401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2256011100OtherMEDICAL ASSISTANCE