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General NPI Number Information
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NPI Number | 1063760650
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Entity Type | Individual
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Provider Name | MICAH N. BECKSTEAD PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 11/15/2018
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Provider Practice Location Address
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Address Line | 1255 S. CEDAR CREST BLVD. SUITE 2200
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City | ALLENTOWN
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State | PA
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Zip | 18103-6226
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Country | US
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Telephone | 610-437-9006
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Fax | 610-437-1942
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Provider Business Mailing Address
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Address Line | PO BOX 1754
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City | ALLENTOWN
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State | PA
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Zip | 18105-1754
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Country | US
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Telephone | 484-884-4500
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Fax | 484-884-0699
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA055716
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License Number State | PA
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