MEDICARE: CHARLIE BECKNELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	21532	KY
2	207NS0135X	Procedural Dermatology Physician	21532	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0300056	OTHER	KY	UNITED HEALTHCARE
2	C03007	OTHER		CUMBERLAND HEALTHCARE
3	000000044793	OTHER		ANTHEM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033112453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLIE BECKNELL M.D.

Provider Business Mailing Address
First Line	:	250 FOUNTAIN CT
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1888
Country	:	US
Telephone Number	:	859-263-4444
Fax Number	:	859-254-1814

Provider Business Practice Location Address
First Line	:	250 FOUNTAIN CT
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1888
Country	:	US
Telephone Number	:	859-263-4444
Fax Number	:	859-254-1814

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	12/16/2013

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