Healthcare Provider Details

I. General information

NPI: 1629016357
Provider Name (Legal Business Name): EDWARD A BEAGELL D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 W BROAD ST
BETHLEHEM PA
18018-3354
US

IV. Provider business mailing address

1806 W BROAD ST
BETHLEHEM PA
18018-3354
US

V. Phone/Fax

Practice location:
  • Phone: 610-868-8681
  • Fax: 610-694-8781
Mailing address:
  • Phone: 610-868-8681
  • Fax: 610-694-8781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberSC-003475-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: