Healthcare Provider Details

I. General information

NPI: 1104914258
Provider Name (Legal Business Name): DR. MARTIN G BEGLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S STATE STREET DEPT OF RADIOLOGY
DOVER DE
19901-3530
US

IV. Provider business mailing address

10850 W. PARK PLACE SUITE 1100
MILWAUKEE WI
53224-3606
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-2202
  • Fax:
Mailing address:
  • Phone: 414-359-5745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC1-0003598
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: