MEDICARE: CHRISTOPHER DONOVAN BECKETT DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	1875	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174575898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER DONOVAN BECKETT DO

Provider Business Mailing Address
First Line	:	PO BOX 300
Second Line	:
City	:	WILLIAMSON
State	:	WV
Zip	:	25661-0300
Country	:	US
Telephone Number	:	304-235-1844
Fax Number	:	304-235-2933

Provider Business Practice Location Address
First Line	:	184 E 2ND AVE
Second Line	:	SUITE 1
City	:	WILLIAMSON
State	:	WV
Zip	:	25661-3602
Country	:	US
Telephone Number	:	304-235-1844
Fax Number	:	304-235-2933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	01/26/2010

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