Provider Demographics
NPI:1215933098
Name:BEEDE, MICHAEL SCOTT (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SCOTT
Last Name:BEEDE
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ANN KLEIN FORENSIC CENTER, 1609 STUYVESANT AVENUE
Mailing Address - Street 2:PO BOX 7717
Mailing Address - City:WEST TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08628
Mailing Address - Country:US
Mailing Address - Phone:609-633-6351
Mailing Address - Fax:609-633-2969
Practice Address - Street 1:ANN KLEIN FORENSIC CENTER
Practice Address - Street 2:1609 STUYVESANT AVENUE
Practice Address - City:WEST TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08628-0717
Practice Address - Country:US
Practice Address - Phone:609-633-6351
Practice Address - Fax:609-633-2969
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04958400207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B29661Medicare UPIN