Healthcare Provider Details

I. General information

NPI: 1851333603
Provider Name (Legal Business Name): CHARMAGNE GOODMAN BECKETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE INFECTIOUS DISEASES
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

13203 BIG CEDAR LN
BOWIE MD
20720-4689
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-6400
  • Fax:
Mailing address:
  • Phone: 301-464-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101056175
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: