1366423907 NPI number — ANDREW W BECKWITH M.D

Table of content: ANDREW W BECKWITH M.D (NPI 1366423907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366423907 NPI number — ANDREW W BECKWITH M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BECKWITH
Provider First Name:
ANDREW
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366423907
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 30
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREAT BARRINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-528-9311
Provider Business Mailing Address Fax Number:
413-644-0274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
780 MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
GREAT BARRINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-528-1470
Provider Business Practice Location Address Fax Number:
413-528-3167
Provider Enumeration Date:
11/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  223952 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 043517461 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043517461 . This is a "HMC PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: J2889 . This is a "HMO BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7731649 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10098934 . This is a "CAPITAL DISTRICT PHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2108968 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA31086 . This is a "HARVARD COMM HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3137730 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4144072 . This is a "MVP SELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110041473A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80314 . This is a "GIC INDEMNITY PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: I34223 . This is a "MEDICARE UPIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0035606 . This is a "NEIGHBORHOOD HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000030797 . This is a "BMC HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 36366 . This is a "HEATH NEW ENGLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5619731 . This is a "HCVM FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 87582 . This is a "HEALTHY START" identifier . This identifiers is of the category "OTHER".
  • Identifier: J28789 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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