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General NPI Number Information
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NPI Number | 1477540938
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Entity Type | Individual
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Provider Name | CONSTANCE BECKOM MD
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Gender | Female
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 01/08/2021
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Provider Practice Location Address
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Address Line | 203 E 4TH AVE
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City | RANSON
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State | WV
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Zip | 25438-1617
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Country | US
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Telephone | 304-725-6343
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Fax | 304-725-5523
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Provider Business Mailing Address
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Address Line | 203 E 4TH AVE
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City | RANSON
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State | WV
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Zip | 25438-1617
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Country | US
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Telephone | 304-725-6343
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Fax | 304-725-5523
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14590
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 26847
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License Number State | WV
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