Provider Demographics
NPI:1962570556
Name:BECKLEY PHYSICIANS GROUP PLLC
Entity type:Organization
Organization Name:BECKLEY PHYSICIANS GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-255-1002
Mailing Address - Street 1:179 WOODLAND DRIVE
Mailing Address - Street 2:STE 202
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801
Mailing Address - Country:US
Mailing Address - Phone:304-255-1002
Mailing Address - Fax:304-253-1871
Practice Address - Street 1:179 WOODLAND DRIVE
Practice Address - Street 2:STE 202
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:304-255-1002
Practice Address - Fax:304-253-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005023Medicaid
WV9310371Medicare ID - Type Unspecified