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NPI Code Detail

MEDICARE: DR. WAYNE AGGREY BECKLES ED.D.

MEDICARE:  DR. WAYNE AGGREY BECKLES  ED.D.
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
11041C0700XClinical Social Worker07040MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12256011100OTHERMDMEDICAL ASSISTANCE

General Provider Information

NPI Number : 1770812612
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WAYNE AGGREY BECKLES ED.D.
Provider Business Mailing Address
First Line : 312 RUSSO WAY APT I
Second Line :
City : BEL AIR
State : MD
Zip : 21015-6463
Country : US
Telephone Number : 301-377-1610
Fax Number :
Provider Business Practice Location Address
First Line : 6710 OXON HILL RD STE 202
Second Line :
City : OXON HILL
State : MD
Zip : 20745-1124
Country : US
Telephone Number : 301-377-1610
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2009
Last Update Date : 03/21/2019

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