Healthcare Provider Details

I. General information

NPI: 1598785628
Provider Name (Legal Business Name): CARL E BECKLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 VT ROUTE 149 METTOWEE VALLEY FAMILY HEALTH CENTER
WEST PAWLET VT
05775-9798
US

IV. Provider business mailing address

71 ALLEN ST STE 403
RUTLAND VT
05701-4570
US

V. Phone/Fax

Practice location:
  • Phone: 802-645-0580
  • Fax: 802-645-0587
Mailing address:
  • Phone: 802-772-4414
  • Fax: 802-772-7973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042-0008190
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: