Healthcare Provider Details

I. General information

NPI: 1376531434
Provider Name (Legal Business Name): SCOTT BENEDICT BEICHNER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 MARKET ST
BOARDMAN OH
44512-3457
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-746-8100
  • Fax:
Mailing address:
  • Phone: 330-746-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34.006950
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: