Provider Demographics
NPI:1215939178
Name:BECKWITH, WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BECKWITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 S BROAD ST
Mailing Address - Street 2:STE 300 ATTN ANGELA MIDDLETON
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-1536
Mailing Address - Country:US
Mailing Address - Phone:215-462-7100
Mailing Address - Fax:215-463-3820
Practice Address - Street 1:1703 S BROAD ST
Practice Address - Street 2:STE 300
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19148-1536
Practice Address - Country:US
Practice Address - Phone:215-462-7100
Practice Address - Fax:215-463-3820
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD008012E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006283900001Medicaid
D71065Medicare UPIN
PA0006283900001Medicaid