Healthcare Provider Details

I. General information

NPI: 1518921683
Provider Name (Legal Business Name): DR. EVAN M BECKMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MOFFAT RD
WABAN MA
02468-1133
US

IV. Provider business mailing address

125 MOFFAT RD
WABAN MA
02468-1133
US

V. Phone/Fax

Practice location:
  • Phone: 617-916-1685
  • Fax:
Mailing address:
  • Phone: 617-916-1685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number73977
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: